Texas State Board of Examiners of Psychologists



Texas Behavioral Health Executive Council

Texas State Board of Social Worker Examiners

Temporary LMSW License Application Form

**NOTE: You must have a current application on file for licensure as an LMSW AND you must never have taken the ASWB examination for LMSW in order to qualify for temporary licensure.

Checklist

All Applicants:

Complete, Signed Application

Application Fee (check, money order). See 22 TAC 885.1 for a list of the fee amounts.

Proof of Completion of Texas Jurisprudence Exam for Social Workers

Application for full licensure, if not already submitted

Official Transcript showing conferral of degree—must be sent to board by

university/sealed envelope from university, if not already submitted

Self-query report from NPDB (must be received in sealed envelope from NPDB)



Additional Items Needed if Applicant Is Licensed in Another Jurisdiction:

Official Verification of Licensure in other Jurisdiction sent to board by other state

Please include your name (or file number) legibly on ALL documents. Submit all documents with application, if possible. If you have applied online, please attach supporting documents electronically to online application. Transcripts, verifications of licensure, and official exam scores must be submitted in an unopened envelope or emailed directly from the school/issuing authority to the Board.

Mail to:

TX BHEC TSBSWE

333 Guadalupe, Ste. 3-900

Austin TX 78701

Texas Behavioral Health Executive Council

TEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS

TEMPORARY LMSW LICENSE APPLICATION FORM

|Name |      | | |

|Mailing address: |      | | |

|Street | | | |

|City, State, Zip |      | |      |

|Phone |      | | |

SSN: DOB:

Email      

|1. I have a current application for regular licensure already on file. Yes No |

|2. I am submitting application Form A at this time. Yes No |

| |If you checked no, to both of the previous questions, do not continue. You must be under application for regular licensure to be |

| |eligible for a temporary license. |

|3. I have read and understood TSBSWE rules regarding Temporary Licensure, 22 Texas Administrative Code (TAC) §781.411. I also understand |

|that I may not begin any supervision process for credit toward advanced licensure or specialty recognition until a regular license is |

|issued. Yes No |

|4. I have completed the TSBSWE jurisprudence examination Yes No |

|(You should maintain your certificate of completion.) |

|Acknowledgements: |

|______ I understand that I may obtain a temporary social work license as long as I meet all requirements, except the licensing examination, |

|for the license category the applicant seeks. |

|______I understand I must take the designated examination within six months of issuance of the temporary license. |

|______I understand that the temporary license is valid until I attempt the appropriate examination or the end of the six-month issuance of |

|the temporary license, whichever occurs first. |

|______I understand I must display the temporary license at my place of business/employment and must use the appropriate licensed title or |

|initials followed by the word "Temporary" in all professional use of my name. |

|______I understand that should I take and fail the examination, the temporary license is no longer valid and that I must cease and desist |

|from the use of the temporary license and title and return the license certificate and certificate card to the board. |

|______I understand that should I pass the examination, the board will issue the license or specialty recognition in accordance with 22 TAC |

|§781.405(g) (relating to Application For Licensure). A temporary license holder who has passed the licensing examination continues to be |

|temporarily licensed until the board issues a regular license or the temporary license expires. |

|______I understand that a person who failed the examination and is without a valid temporary license may retake the examination under 22 TAC|

|§781.412 (relating to Examination Requirement). |

|______I understand that a temporary license will not be granted to an applicant who has held a temporary license for the same license |

|category previously within his/her lifetime. |

|______I understand that an applicant for LCSW or specialty recognition is not eligible for a temporary or provisional license. |

|______I understand that an applicant requesting a temporary license must submit the application form and temporary fee required by the |

|board. |

|I am requesting a temporary license. |

|______________________________________________ _______________ |

|Signature Date |

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