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BOARD OF EXAMINERS FOR SOCIAL WORKERS PLEASE READ (State of Nevada, Department of Information Technology)

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PLEASE READ BEFORE COMPLETING APPLICATION
Information for Licensure:
CLINICALSOCIAL WORKER (LCSW) OR INDEPENDENT SOCIAL WORKER (LISW)
Pursuant to Nevada Revised Statute 641B.500, it is unlawful for any person to represent him/herself as
a social worker without a license. You may not engage in the practice of social work until you are
licensed.
EACH item on the enclosed application must be completed. Once ALL information has been received by the
Board, the application will be processed. Allow forty-five (45) days for processing of the completed application.
Failure to provide requested information will result in a delay or rejection of the application as incomplete. The
information provided will be used for identification and to determine qualification for licensure per Nevada
Revised Statutes (NRS) and Nevada Administrative Code (NAC), Chapter 641B, which authorizes collection of
this information.
GE
NERAL QUALIFICATIONS / REQUIREMENTS
1. Applicant must be at least twenty-one (21) years of age.
2. Applicant must be a United States citizen or must be lawfully entitled to remain and work in the United
States.
a. U.S. citizens must submit a copy of their birth certificate or passport. (Hospital certificates are not
acceptable).
b. Naturalized citizens must forward a copy of their naturalization certificate.
c. Aliens must submit a copy of documentation from the United States Immigration and
Naturalization Service evidencing the lawful entitlement of the applicant to remain and work in the
United States.
3. A copy of current, legible, official government photo identification (i.e. Driver’s License)
4. Copies of legal documents must be submitted verifying all name changes from birth to current name.
5. All applicants for licensure must submit to the Board two complete sets of his/her fingerprints and
accompanying waiver form, authorizing the Board to process the fingerprint cards. Applicants will be
sent the Fingerprint Packet upon receipt of their application (or with the exam packet if the exam is
required). The applicant is responsible for the fees required to complete the background check. A
money order or certified check in the amount of $36.25 made payable to the Nevada Dept. of
Public Safety (NV DPS) must be submitted with the Fingerprint Packet. Changes to fingerprint fees
are beyond the Board’s control. It is highly recommended that applicants check the Board’s website for
any fee changes prior to sending in the fingerprint cards. Fees incorrectly received will be rejected.
6. Applicant must possess a master’s degree in Social Work from a college or university accredited by the
Council on Social Work Education or which is a candidate for such accreditation. An applicant must
request that the college or university from which (s)he graduated forward directly to the Board a certified
transcript of his / her educational coursework and the degree awarded.
a. In addition to a transcript sent directly to the Board from his / her university, a graduate of a
foreign social work program must also submit the appropriate forms and documentation to the
Council on Social Work Education for evaluation of foreign credentials and cause the Council
on Social Work Education to submit an original letter to the Board verifying equivalency.
7. Applicants who have previously been certified, registered or licensed to practice social work in another
state must request verification of certification, registration, or licensure be sent directly to the Board from
each state. See form on the website -- http://socwork.nv.gov/.
STATE OF NEVADA
BOARD OF EXAMINERS FOR SOCIAL WORKERS
4600 Kietzke Lane, Suite C121, Reno, Nevada 89502
775-688-2555
8. Applicants who hold a current license, in good standing, to engage in the practice of clinical /
independent social work in another state, may apply for licensure via Endorsement if the requirements at
the time the license was issued are substantially equivalent to the requirements in Nevada.
9. Applicant must have passed an examination given by the Association of Social Work Boards (ASWB), or
an exam accepted by the Board, equivalent to the level of licensure requested if licensed less than fiv
e
(
5)
y
ears. Once the completed application for licensure with all supporting documents and fees have
been received and the application is approved, the applicant will receive an “exam approval letter” if
required. An examination fee will be required by ASWB when you register to take the examination (see
below).
a. An applicant requesting licensure as a Clinical Social Worker (LCSW) must show proof of a
satisfactory score on the ASWB Clinical examination or Board accepted alternate exam
.
b. An applicant requesting licensure as an Independent Social Worker (LISW) must show proof of a
s
atisfactory score on the ASWB Advanced Generalist Exam or Board accepted alternate exam.
c. An applicant who has taken the ASWB examination in another state must have verification of
examination results sent directly to the Board from the state for which examination was taken or
from ASWB. See form on the website -- http://socwork.nv.gov/
.
A separate examination fee payable directly to ASWB will be required at the time you register to take the
examination. Please go to the ASWB website, www.aswb.org for the most up-to-date list of examination fees.
FINAL APPROVAL FOR LICENSURE WILL OCCUR AFTER RECEIPT OF THE BACKGROUND CHECK
REPORTS.
An application for licensure, which is not completed within one (1) year, will be considered to have lapsed /
closed. The Board will not refund any fee related to an application, which has lapsed / closed.
Please refer to NRS 641B and NAC 641B for specific laws and statutes about licensure. Links to these
documents can be found at the Board website - http://socwork.nv.gov/
.
LCSW / LISW License Types – Choose ONE
In
itial LCSW / LISW license
• Master’s Degree in Social Work from a CSWE accredited program.
• Meets all other criteria listed on pages one (1) and two (2) of this application packet.
In
itial LCSW / LISW license – Armed Forces
• Master’s Degree in Social Work from a CSWE accredited program.
• Meets all other criteria listed on pages one (1) and two (2) of this application packet.
• Holds an equivalent, current, valid and unrestricted license to engage in clinical / independent social work
in another state(s).
• Has requested completion of the Verification of Social Work Licensure from Another State
endorsement form from each state licensed. THIS FORM MUST BE COMPLETED BY THE LICENSING
ENTITY, FOR EACH STATE, AND SUBMITTED DIRECTLY TO THE BOARD. This document can be
found on the Board’s website at http://socwork.nv.gov/licensees/LicNewApp/
.
• Has a clear background check report from the Federal Bureau of Investigation (FBI) and Nevada
D
epartment of Public Safety (NVDPS).
• Has verified eligibility as an active member of, or the spouse of an active member of the Armed Forces
of the United States; is a veteran or a veteran’s surviving spouse. Approved verification informati
on
can be found be found on the Board’s website at:
http://socwork.nv.gov/uploadedFiles/socworknvgov/content/licensees/Attachment2.pdf
Provisional LCSW / LISW license (two types)
Provisional “A” – Temporary 90-day License
• Master’s Degree in Social Work from a CSWE accredited program.
• Meets all other criteria for licensure listed on pages one (1) and two (2) of this applic
ation packet.
• Has not taken appropriate licensing exam through ASWB.
Can be granted a “provisional license” for a period of ninety (90) days once Board has given exam
approval. The exam must be passed within sixty (60) days. This license is valid for one attempt of
the exam only and an applicant may be issued only one provisional license.
P
rovisional “C – Temporary Endorsement of Current, Valid Out-of-State Social Work License
• Has submitted a completed application with accompanying fees.
• Has submitted preliminary information which can be verified by the Board including:
A clear photocopy of a current, official form of government identification which contains a photograp
h
o
f the applicant, verifying the applicant’s identity.
Supporting documentation that the applicant is a citizen of the United States or otherwise has t
he
l
egal right to remain and work in the United States.
• Submits two sets of completed fingerprint cards, signed waiver authorizing the Board to process the
fingerprint cards, and appropriate processing fee.
• Has submitted the “Provisional ‘C’” notarized affidavit (form available on the Board website), stating:
The information submitted by the applicant, including any accompanying material or documents
submitted during the entire application process is true and correct.
The applicant holds a corresponding valid and unrestricted license to engage in clinical / independent
social work in another state(s) or U.S. territory.
(S)he has not been disciplined, investigated or is under investigation by a corresponding regulatory
agency in another state(s) or U.S. territory.
(S)he has not been held civilly or criminally liable for malpractice in any other state(s) or U.S. territory.
Can be granted a “provisional license” for a period of one (1) year during which time the applicant
will ensure that any and all supporting documentation is received by the Board. Failure to produce
required documentation will result in expiration of the provisional license one (1) year after it’s
issuance.
Licensure by Endorsement
• Has submitted a completed application with accompanying fees.
• Holds an equivalent, current, valid and unrestricted license to engage in social work in another state(s).
• Has requested completion of the Verification of Social Work Licensure from Another State
endorsement form from each state licensed. THIS FORM MUST BE COMPLETED BY THE LICENSING
ENTITY, FOR EACH STATE, AND SUBMITTED DIRECTLY TO THE BOARD. This document can be
found on the Board’s website at http://socwork.nv.gov/licensees/LicNewApp/.
• Has a clear background check report from the Federal Bureau of Investigation (FBI) and Nevada
Department of Public Safety (NVDPS).
• If the licensee has been continuously licensed to engage in the practice of clinical / independent
social work for at least five (5) years immediately preceding the date of the application to the
Board, then (s)he will be eligible for expedited endorsement and will need to provide only the
information listed above.
• If the licensee has NOT been continuously licensed to engage in the practice of
clinical /independent social work for at least five (5) years immediately preceding the
date of the application then (s)he will need to provide information to support that his / her
experience is “substantially equivalent” to the requirements for licensure in Nevada. See
below for required documentation.
For a Clinical License, applicant must provide evidence of 3000 hours of postgraduate practice of
clinical social work supervised by a Licensed Clinical Social Worker. At least 2000 of these hours
must be in the area of psychotherapeutic methods and techniques with individuals, couples,
families and groups to help in the diagnosis and treatment of mental, emotional and behavioral
disorders, conditions and addictions.
For an Independent License, applicant must provide evidence of 3000 hours of postgraduate
practice of independent social work supervised by a Licensed Clinical Social Worker. These
hours must include advanced practitioner level of activity in the ability to assist persons, groups,
agencies, organizations or communities to enhance or restore their ability to function physically,
socially and economically by the application of methods, principles and techniques of case work,
group work, community organization, administration, planning, consultation, and research.
Additional documents needed to verify “substantially equivalency”
Initials
Agency job description(s) under which internship hours were completed.
Copies of records submitted to your Board regarding post-graduate internship hours.
Qualifications of individual(s) who provided supervision during post-graduate internship hours.
Application Checklist – LCSW or LISW License
ALL FEES MUST BE INCLUDED WITH THE NOTARIZED APPLICATION
OR THE APPLICATION WILL NOT BE PROCESSED.
Use the checklist below to ensure that you have submitted all required items for the social work application. Some
items may not apply.
Initials
Application with all information provided.
If you answered “yes” to any of questions one (1) through eight (8) on the application, you must
provide the Board with requested information detailed below. The applicant may be required to
appear before the Board if deemed necessary.
Explanations for questions one (1) and two (2) on application.
See explanation of specific information required below.
Explanations for questions three (3), four (4), and five (5) on application.
See explanation of specific information required below.
Explanations for question six (6) on application.
See explanation of specific information required below.
Fees
Application Fee of $40.00 (all applicants).
Initial License Fee of $100.00 OR Armed Forces Initial License Fee of $50.00
Additional Fees (select as appropriate)
Provisional License “A” Fee of $75.00
Provisional License “C” Fee (includes $100.00 Endorsement fee) of $175.00
Endorsement Fee of $100.00 if applicant is seeking licensure by endorsement.
TOTAL FEES SUBMITTED $
This can be a personal check, certified or cashier’s check or money order made out the Board
of Examiners for Social Workers. A $30.00 fee is assessed on all returned checks.
Copy of Birth Certificate or Passport OR Naturalization Documents OR Documentation from the
United States Immigration and Naturalization Service evidencing the lawful entitlement of the
applicant to remain and work in the United States.
Copy of current, legible, official government photo identification (i.e. Driver’s License)
Copy of all legal documents verifying all name changes from birth.
Use the checklist below to ensure that you have requested all required items for the social work application.
Some items may not apply.
Initials
I have requested certified transcripts be sent directly to the Board verifying my coursework and
degree.
I have been, or am currently, certified, registered, or licensed to practice social work in other
state(s). I have requested Verification of Social Work Licensure from Another State be sent
directly to the Board. Forms are available at the Board website.
I have previously taken an examination given by the Association of Social Work Boards (ASWB). I
have requested verification of my test score from ASWB. Forms are available at the Board
website.
My initials serve as acknowledgement of inclusion of required items or requests for items required for
license application. Include this document with your application.
Print Name:
Initials Signature Date
Explanations to questions one (1) and two (2).
These questions deal with the following –
• Prior felony convictions; and / or convictions of criminal or civil offenses; and / or convictions for possession,
distribution or use of a controlled substance or dangerous drug.
The Board considers each application on a case by case basis. The following information is required if you have
answered “yes” to questions one (1) and / or two (2).
1. A court certified copy of the conviction and final or most recent disposition of your case(s) from the Court
Clerk of the court in which convicted.
2. A letter from you describing the underlying circumstances of the conviction including the nature of the act(s)
or crime(s) and the date(s) of the crime.
3. A letter from you describing rehabilitation efforts or changes you have made to prevent future problems. It is
your responsibility to present sufficient evidence of rehabilitation to demonstrate your fitness for licensure.
The evidence of rehabilitation may include, but is not limited to:
a. An evaluation by a mental health practitioner that addresses the problem and fitness for social work
licensure.
b. Proof of completion of probation if it was required.
c. Letters of reference from employers, instructors, professional counselors, probation or parole officers on
official letterhead.
The Board may request additional information as it deems necessary. Information provided will be compared to
the information received from the legal background check. If this information does not match, the application
process will be pended until the discrepancies are addressed to the Board’s satisfaction.
Expl
anations to questions three (3) through five (5).
These questions deal with the following –
• Prior denial of certification / licensure; prior denial of approval to take a licensing exam; being subject to an
administrative action / proceeding relating to a professional certification / license; disciplined for
unprofessional conduct or professional incompetence.
The Board considers each application on a case by case basis. The following information is required if you have
answered “yes” to questions three (3) through five (5).
1. A letter from you describing the circumstance of the incident.
2. A certified copy of the determination made by the licensing or professional entity.
3. If disciplinary action was imposed, the abov
e document should include date and location of the incident,
specific violation, date of disciplinary action, and sanctions or penalties imposed.
4. If disciplinary action was imposed, a letter from you describing rehabilitation efforts or changes you have
made to prevent further problems. It is your responsibility to present sufficient evidence of rehabilitation
to demonstrate your fitness for licensure. The evidence of rehabilitation may include, but is not limited to:
a. An evaluation by a mental health practitioner that addresses the problem and fitness for social work
licensure.
b. Proof of completion of probation if it was required.
c. Letters of reference from employers, instructors, professional counselors, probation or parole officers
on official letterhead.
The
Board may request additional information as it deems necessary.
Expl
anations to question six (6).
These questions deal with the following –
• Any current condition or impairment, including substance abuse, alcohol abuse, mental and / or medical
conditions which currently affect delivery of social work services.
The Board considers each application on a case by case basis. The following information is required if you
have answered “yes” to question six (6).
1. A letter from you outlining the circumstances.
The Board may request additional information as it deems necessary.
STATE OF NEVADA
Board of Examiners for Social Workers
Applica
tion for Social Worker License
Independent Social Worker Clinical Social Worker
Please read instructions before completing this fillable form or print in blue or black ink.
General Information
Present Legal Name:
Last First Middle
List any other name(s) ever used:
Mailing Address:
Street City State Zip
Telephone ( ) Social Security Number: Date of Birth:
What license type are you applying for (see instructions for description)? Initial Armed Forces Initial
Yes
Provisional “A” Provisional “C” General Endorsement
Are you currently, or have you ever been licensed, registered or certified as a social worker in another state(s)?
No
Yes If “yes,” which state(s)
Have
you ever taken an ASWB examination? No Yes If “yes,” date taken
If “yes,” which level? Masters Advanced Generalist Clinical
Have you completed 3000 postgraduate hours specific to the license you are applying for? No
If “no,”
have you included an application for an internship program? Yes No
What other professional Nevada state licenses or certifications do you currently hold?
Citizenship: U.S. Citizen Alien Registration Number Other
Submit a copy of birth certificate, passport, certificate of naturalization or alien registration card with application.
Employment History: List ten (10) years of work history in chronological order beginning with most recent (explain
any gaps in employment). Add additional sheets if necessary.
Employer Address Telephone
Position Supervisor Dates of Employment
Duties
Employer Address Telephone
Position Supervisor Dates of Employment
Duties
Employer Address Telephone
Position Supervisor Dates of Employment
Duties
Board Use Only
Date Received Check # Amount
Education:
A copy of a certified transcript showing the degree awarded must be received directly from the school.
Name of School Location Major Degree Degree
Date Awarded
Yes
No
1. Have you ever been convicted of a felony?
2. Have you ever been convicted of a criminal or civil offense and / or convicted of possession,
distribution or use of a controlled substance or dangerous drug?
3. Have you ever been denied a license or certification or been denied approval to take a licensing
examination?
4. Have you ever been the subject of an administrative action / proceeding relating to a professional
license or certification?
5. Have you ever been disciplined for unprofessional conduct or professional incompetence?
6. Do you currently have any condition or impairment (including, but not limited to, substance abuse,
alcohol abuse, mental and / or medical condition) which currently affects your ability to deliver
essential social work services?
If the answer to any of the above questions is “yes,” a signed statement of explanation must be attached.
Copies of any documents that identify the circumstances or contain an order, or agreement, or other
disposition are required.
Email Address:
The Board may use this email address to communicate with you. This email address will be added to the Board
Listserv, which is used to disseminate information pertinent to all licensees.
Child Support Information: Please check the appropriate answer. It is mandatory that you answer this question.
a. I am not subject to a court order for the support of child.
b. I am subject to a court order for the support of one or more children and am in compliance with the order
or am in compliance with a plan approved by the district attorney or other public agency enforcing the
order for the repayment of the amount owed pursuant to the order.
c. I am subject to a court order for the support of one or more children and am not in compliance with the
order or a plan approved by the district attorney or other public agency enforcing the order for the
repayment of the amount owed pursuant to the order.
Armed Forces / Veterans: Please check the appropriate answer. The term “veteran” has the meaning ascribed to
it, pursuant to NRS 417.005.
a. I have NO SERVICE in the Armed Forces, Commissioned Corps of the United States PHS or the
Commissioned Corp of NOAA and served in the capacity of a commissioned officer while on active duty.
b. I am an active member of the Armed Forces.
c. I am a veteran of the Armed Forces.
d. Other – Commissioned Corps of the U.S. PHS or the Commissioned Corps of NOAA and served in the
capacity of a commissioned officer while on active duty.
I have read all questions, answers and statements and know the content thereof. I hereby certify under the penalty of
perjury that the information furnished on this document is true and correct.
I hereby authorize the Board of Examiners for Social Workers, its agents and employees, to conduct any investigation(s) of
my business, professional, social and moral background, qualifications and reputation, as it may deem necessary, proper
or desirable. No liability of any sort or kind shall attach itself to the said Board of Examiners for Social Workers, its members,
or employees or by reason of the use of the authorization.
Dated Signature of Applicant
Subscribed and sworn to before me this
day of
Month / Year
Signature of Notary
Notary Public for State of
My commission expires
Notary Seal
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Completed 3 January 2022

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