Applications & Forms

Registration of Supervision toward LCSW Licensure

Click here to begin the online application process for Initial and Add/Change Registration of Supervision toward LCSW licensure.

• Sample Template Supervisory Contract (Word document)
• LCSW Supervision Log Template (Word document)
• Verification of Clinical Supervision
• Request for Termination of Supervision
• Verification of Education & Field Placement/Practicum Hours

Licensed Clinical Social Worker  (LCSW Examination & Endorsement)

Click here to begin the online application process for Licensure by Examination and Endorsement as a Licensed Clinical Social Worker (LCSW).

Licensed Master's Social Worker  (LMSW Examination & Endorsement)

 Click here to begin the online application process for Licensure by Examination and Endorsement as a Licensed Master's Social Worker (LMSW).

Licensed Baccalaureate Social Worker (LBSW Examination & Endorsement)

 Click here to begin the online application process for Licensure by Examination and Endorsement as a Licensed Baccalaureate Social Worker (LBSW).

Reinstatement

Reinstatement following Disciplinary Action- LBSW, LMSW and LCSW

Reinstatement - LBSW LMSW 

Reinstatement - LCSW

Miscellaneous Forms

Social Work Name/Address Change Form

Request for Change of Status (Active to Inactive)

Request for Change of Status (Inactive to Active)

Request for Verification of Virginia License

Out-of-state temporary practitioner reporting form

Applicant Out-of-state Licensure Verification

Extension Request for Supervised Experience

Continuing Education Forms

Compliance Forms and Information

Compliance FAQs

Initial Contact Form

Approval Request Forms

CE and Education Approval Request

Evaluator Approval Request

Compliance Supervisor Request

Therapist Approval Request

Reports

Employer Notification Form

Group Attendance Report

Physician Prescription Report

Self-Report

Supervisor Report

Therapy Report (Initial)

Therapy Report (Quarterly)