LMSW Application Forms

Instructions for completing and submitting the forms required for licensure appear below. You may also need to submit additional information (for example, examination scores). Please refer to the license requirements link on the left for complete information regarding all requirements you must meet.

Note: All forms are in Adobe Portable Document Format (PDF). To view or print these documents, you will need to have the free Adobe Reader External Link Icon installed on your computer. Download times and print quality will depend on your connection speed and printer.

Please type or print all information and sign all forms in black or blue ink. Original signatures are required on all forms.

Complete Application Packet
All forms and instructions in a single PDF file - Licensed Master Social Worker Licensing Application Packet ( PDF 156 KB)

Individual Application Forms

Form 1 - Application for Licensure - ( PDF 30 KB)

Important Notice: A New York State professional license is valid for life unless it is revoked, annulled, or suspended by the Board of Regents. To practice in New York State your professional license must be registered. If your registration has lapsed and you need to reregister, do not submit a Form 1. Instead, contact the Registration and Fees Unit to request a Delayed Registration Application by e-mailing: OPREGFEE@mail.nysed.gov, or by calling 518-474-3817 Ext. 410.  When e-mailing, be sure to include your profession, license number, address on record, new address (if changed), date of birth and the last 4 digits of your SSN.

All applicants for licensure must complete this form and submit it with the $294 licensure and first registration fee directly to the Office of the Professions at the mailing address at the end of Form 1. Make checks payable to the New York State Education Department. NOTE: Your cancelled check is your receipt.

You must answer all questions and provide all information requested unless otherwise indicated. Failure to complete all required parts of the application will delay its review. Your signature on Form 1 must be notarized by a Notary Public.

Address/Name Change Form - Optional ( PDF 22 KB)
You are required to notify us within 30 days of any name or address changes. Please read the instructions and complete the appropriate sections of this form.
 
Form 2 - Certification of Professional Education - ( PDF 17 KB)
This form must be submitted directly by the educational institution(s) you attended. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section before sending the entire form to your school. Be sure to sign and date item 9.
  • Section II: The Registrar must complete this section and return both pages of the form in an official school envelope with requested documents directly to the Office of the Professions at the address at the end of the form.

If you attended a social work program not registered as licensure-qualifying by the New York State Education Department, you must also ask your school to submit an official transcript or marksheets.

Please photocopy this form as needed.

Form 3 - Verification of Other Professional Licensure/Certification - ( PDF 18 KB)
Complete this form if you hold, or ever held, a license or certificate to practice any profession* in any jurisdiction.

This form must be submitted directly by the licensing/certifying authority. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section before sending the entire form to the licensing/certifying authority of each jurisdiction in which you are or have been licensed/certified. Be sure to sign and date item 8.
  • Section II: The licensing/certifying authority must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

NOTE: A Form 3 is not required for licenses/certificates issued by the New York State Education Department.

*Profession is defined as professional titles licensed under New York State Education Law. (See page 2 of the Address/Name Change Form ( PDF 22 KB) for a list of those titles.)

Form 4Q - Approval of Qualifications to Supervise Psychotherapy - ( PDF 20 KB)
This form must be submitted directly by the supervisor. The Office of the Professions will not accept this form if submitted by the applicant.

This form must be submitted if your supervisor is not an LCSW or has not already been approved by the State Education Department to supervise the provision of psychotherapy services by an LMSW.

  • Section I: Complete this section before giving the entire form and a copy of Appendix A to your supervisor.
  • Section II: Your supervisor must complete this section and return both pages of this form directly to the Office of the Professions at the address at the end of the form.

Please photocopy this form as needed but all forms submitted must bear original signatures and be notarized by a Notary Public.

Note: The supervisor may submit the Form 4Q prior to supervising your experience. Approval of the supervisor does not guarantee approval of the applicant's experience which must be completed in accordance with the requirements in the Commissioner's Regulations.

Form 5 - Application for Limited Permit - ( PDF 18 KB)
  • Section I: Complete this section before having your prospective supervisor complete Section II. Be sure to sign and date item 9.
  • Section II: Ask your prospective supervisor to complete this section.

Return the completed form with the $70 fee to the Office of the Professions at the mailing address at the end of the form.

Form 6 - Plan for Supervised Experience - ( PDF 28 KB)
This form must be submitted by the supervisor. The Office of the Professions will not accept this form if submitted by the applicant.
  • Section I: Complete this section and send the entire form to your proposed supervisor. Be sure to sign and date item 7.
  • Section II: The proposed supervisor must complete this section and return the entire form to the Office of the Professions at the address at the end of the form.
 
Child Abuse Certification of Exemption Form ( PDF 17 KB)
This form is not for all applicants. Use this form only if you are applying for an exemption to the requirement to complete training or coursework in the identification of child abuse and maltreatment because the nature of your practice excludes contact with persons under the age of 18 and persons 18 or older with a handicapping condition who reside in a residential care school or facility.
Last Updated: April 9, 2014