SOCIAL WORK LICENSURE INFORMATION - Kentucky
KENTUCKY BOARD OF SOCIAL WORK
bsw. | telephone: 502-564-2350
APPLICATION CHECKLIST FOR OUT-OF-STATE APPLICANTS
Mailing address for applications:
Board of Social Work, 125 Holmes Street, Suite 310, Frankfort, KY 40601
1. Licensed Social Worker (LSW)
Degree required: Bachelors in Social Work from CSWE accredited university or Bachelors
Exam required: ASWB Bachelors exam
Experience required: None
Application – fill in each field, sign and date, see p. 5 below
$25 (twenty-five dollar) application fee – include check or money order payable to KY State Treasurer
Current Job Description
Signed and dated by your HR director or agency supervisor
This means for your job now, not for any job you are hoping to get in the future
If you are taking a new job once you get licensed:
Include a note explaining about your new job, and date of hire; and
Include that job description too
Official Transcript Conferring Bachelors in Social Work
Contact your college or university
Yes, we accept electronic transcripts
Yes, you can mail the verification in yourself
If you don’t have a BSW
Official Score Report
ASWB Bachelors Level Exam
Contact
Official License Verification
From each state or province in which you currently hold or previously held a license
Yes, we accept electronic verifications
Yes, you can mail the verification in yourself
Verification must include whether you have been disciplined or not
KENTUCKY BOARD OF SOCIAL WORK
bsw. | telephone: 502-564-2350
APPLICATION CHECKLIST FOR OUT-OF-STATE APPLICANTS
Mailing address for applications:
Board of Social Work, 125 Holmes Street, Suite 310, Frankfort, KY 40601
Certified Social Worker (CSW)
Degree required: Masters or doctorate in Social Work from CSWE accredited university
Exam required: ASWB Masters exam
Experience required: None
Application – fill in each field, sign and date, see p. 5 below
$25 (twenty-five dollar) application fee – include check or money order payable to KY State Treasurer
Current Job Description
Signed and dated by your HR director or agency supervisor
This means for your job now, not for any job you are hoping to get in the future
If you are taking a new job once you get licensed:
Include a note explaining about your new job, and prospective date of hire, and
Include that job description too
Official Transcript
Conferring Masters or doctorate in Social Work
Contact your college or university
Yes, we accept electronic transcripts
Yes, you can mail the verification in yourself
Official Score Report
ASWB Masters Level Exam
Contact
Official License Verification
From each state or province in which you currently hold or previously held a license
Yes, we accept electronic verifications
Yes, you can mail the verification in yourself
Verification must include whether you have been disciplined or not
KENTUCKY BOARD OF SOCIAL WORK
bsw. | telephone: 502-564-2350
APPLICATION CHECKLIST FOR OUT-OF-STATE APPLICANTS
Mailing address for applications:
Board of Social Work, 125 Holmes Street, Suite 310, Frankfort, KY 40601
Licensed Clinical Social Worker (LCSW)
Degree required: Masters or doctorate in Social Work from CSWE accredited university
Exam required: ASWB Clinical exam
Experience required: 200 hours of supervision or five (5) years of clinical practice
Application – fill in each field, sign and date, see p. 5 below
$25 (twenty-five dollar) application fee – include check or money order payable to KY State Treasurer
Current Job Description
• Signed and dated by your HR director or agency supervisor
• This means for your job now, not for any job you are hoping to get in the future
• If you are taking a new job once you get licensed:
✓ Include a note explaining about your new job, and prospective date of hire, and
✓ Include that job description too
Official Transcript
▪ Conferring Masters or doctorate in Social Work
▪ Contact your college or university
▪ Yes, we accept electronic transcripts
▪ Yes, you can mail the verification in yourself
Official Score Report
• ASWB Bachelors Level Exam
• Contact
Official License Verification
• From each state or province in which you currently hold or previously held a license
• Yes, we accept electronic verifications
• Yes, you can mail the verification in yourself
• Verification must include whether you have been disciplined or not
Documented independent licensure or supervised experience:
1. Five (5) years of independent licensure and active practice of clinical social work
Or
2. 200 hours of supervision with an independent clinical social worker who was licensed for three (3) years at the time of your supervision
Continued on next page . . .
Documentation for independent licensure or supervised experience
If you have practiced independent clinical social work for five (5) years, here are examples of documentation to mail to the board with your application:
• Official job description(s) from employers where you practiced clinical social work services
➢ Cover letter signed by Human Resources Director or Agency Supervisor
➢ Provide the start and end dates of employment
• Letters of recommendation
➢ State the type of clinical social work services you provided, and
➢ State the time period
• Letters approving you as a “credentialed provider”:
➢ Should cover the five-year span of time in which you practiced clinical social work
➢ Can be from:
▪ Government insurance companies such as Medicare, Medicaid, Tricare
▪ Private health insurance providers
• Standard employment forms
➢ Federal civilian employee: Standard Form 50
➢ Active member of the U.S. Armed Services
• Certificate of Liability Insurance
➢ Proof of professional liability insurance coverage for clinical services
➢ For the five year time period
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
If you have NOT been licensed as an independent clinical social worker for five (5) years or more, you have to provide proof of:
200 hours of supervised experience in clinical social work
• Supervision must have been by an independently licensed Clinical Social Worker who has been licensed for a minimum of three (3) years
• Supervision must be documented on the Kentucky form
➢ Supervision: “Supervised Experience Documentation Form”
➢ Include official verification of LCSW supervisor’s license
▪ This is to document that your supervisor had been an independently licensed Clinical Social Worker who has been licensed for a minimum of three (3) years
➢ Include resume of LCSW supervisor
➢ KENTUCKY BOARD OF SOCIAL WORK
COMMONWEALTH OF KENTUCKY
125 HOLMES STREET, SUITE 310
FRANKFORT, KY 40601
bsw.
NOTE: Application fee in the amount of $25 payable to the Kentucky State Treasurer must be submitted with this application in order to process. DO NOT SEND CASH.
APPLICATION FOR: LICENSED SOCIAL WORKER (Bachelor’s Degree)
CERTIFIED SOCIAL WORKER (Master’s Degree)
LICENSED CLINICAL SOCIAL WORKER (Master’s Degree)
THIS IS FOR REINSTATEMENT [LICENSE EXPIRED THREE (3) MONTHS OR MORE]
|1. | | | |2. - - |
| |Name: Last |First |Middle |Social Security Number |
| | |3. / / |
| |Maiden or any other name used |Date of Birth |
|4. | | | | | |
| |Mailing Address: Street |City |State |Zip Code |County Phone |
| | |
| |Personal Email Address |
|5. | | | | | |
| | Current Employer: Address: | City | State | Zip Code | Business Phone |
| | | | | | |
← I am NOT currently EMPLOYED.
← Date of Hire, if currently employed:
← ATTACH AN OFFICIAL JOB description signed by Ex. Dir., Human Resources Director, or Agency Supervisor, regardless of whether you are employed in a social work position or not.
← If you work at a nonprofit, 501 (c) (3) exempt agency, you must submit the official IRS documentation.
Your application will be considered INCOMPLETE, and will not be processed without this information.
|6. |Do you presently hold or have you held a valid license or registration to practice Social Work in KY or any other jurisdiction? | Yes No |
| |If yes, License or Registration Number: | |State: | |
| | | | | |
| |You must submit an OFFICIAL VERIFICATION OF LICENSURE | | | |
| |from each state in which you hold or have held a | | | |
| |license. | | | |
|7. |Have you taken and passed an exam through ASWB? Yes No |If yes, what exam? | |
| | | | |
| |Please contact for an official score transfer. | | |
| |(Not required for current active licensees in KY) | | |
|8. |Have you ever made application and failed to receive a license in Social Work or any other profession in Kentucky or any other | Yes No |
| |state? | |
| |If yes, state reason the application was denied. | |
| | |
|9. |Has your license in Social Work or any other profession in Kentucky or any other state ever been suspended or revoked? | Yes No |
| |If yes, give details and submit supporting documentation. | |
| | |
|10. |Have you ever been convicted of a felony? Yes No. |If yes, what offense? | |
| | | | |
← If yes, attach a CERTIFIED COPY of the court documentation (obtain from the Court Clerk)
EDUCATION
| |Dates Attended |Date of Graduation | |
|SCHOOL |NAME AND LOCATION |From |To |Month |Year |Number of Hours |Degrees |
| | | | | | |or Credits |Obtained |
|Under-Graduate School | | | | | | | |
| | | | | | | | |
|Graduate School | | | | | | | |
| | | | | | | | |
NOTE: All degrees must be documented by an OFFICIAL CERTIFED TRUE TRANSCRIPT with the “DEGREE CONFERRED.” You may attach it to this application or have it mailed directly to this office.
Official “electronic” transcripts will be accepted if the university provides OFFICIAL transcripts electronically.
NO ACTION WILL BE TAKEN ON YOUR APPLICATION UNTIL ALL NECESSARY DOCUMENTS ARE RECEIVED
Once the completed application has been reviewed, you will be notified via email when appropriate, otherwise you will be notified via postal mail.
All applicants are required to read the Kentucky Law and Regulations pertaining to the Practice of Social Work found on our website bsw..
LIST THE NAMES AND ADDRESS OF THREE (3) INDIVIDUALS QUALIFIED TO DOCUMENT YOUR PROFESSIONAL COMPETENCY.
| | |
|1. Name Address | Phone Email Address |
| | |
|2. Name Address | Phone Email Address |
| | |
| | |
|3. Name Address | Phone Email Address |
APPLICANT’S AFFIDAVIT
I do hereby affirm that all statements made herein are true and correct to the best of my knowledge and belief.
I further affirm that I have read KRS 335 as annotated by the board, together with the Rules and Regulations of the Kentucky Board of Social Work and fully understand that in receiving a license from the Board, I bind myself to be governed by them. Furthermore, I voluntarily consent to a thorough investigation of my present and past employment and other activities for the purpose of verifying my qualification for licensing. In addition, I agree to furnish the Board any information that may subsequently be requested for the purpose of verifying my qualifications.
I understand that this application is a legal government document and affirm all information is correct and complete.
| | |
|Date |Signature of Applicant |
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