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This document is an application form to enter into a supervisory process leading to a license as a Licensed Certified Social Worker (LCSW) in the state of Mississippi, requiring personal, educational,
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How to fill out Application to Enter into Contract for Supervision toward Licensed Certified Social Worker Status

01
Obtain the Application to Enter into Contract for Supervision form from your state licensing board's website.
02
Fill out your personal information, including name, address, and contact details.
03
Provide your educational background, including the name of the institution, degree obtained, and graduation date.
04
List any relevant work experience in the field of social work, including positions held and responsibilities.
05
Identify the licensed supervisor with whom you will be working, including their name, credentials, and license number.
06
Include the dates during which the supervision will take place and the anticipated number of hours of supervision.
07
Review the terms and conditions of the supervision contract and confirm your understanding and agreement.
08
Sign and date the application to certify the accuracy of the information provided.
09
Submit the completed application to the relevant state licensing board, along with any required fees.

Who needs Application to Enter into Contract for Supervision toward Licensed Certified Social Worker Status?

01
Individuals who have completed their graduate education in social work and are seeking supervised experience to qualify for Licensed Certified Social Worker status.
02
Recent graduates looking to accrue supervised hours needed for licensure.
03
Social workers currently working under a provisional or associate license who need to formalize their supervision agreement.
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► Supervisors who start supervising for the first time after January 1, 2022 must complete a minimum of 15 hours of supervision training. Must complete the training within 60 days of starting supervision. Training must meet the course provider and course content requirements .
What is the breakdown for the experience required to become a LCSW? California law requires 3,000 hours of supervised post-degree professional experience, including 104 supervised weeks, in order to qualify for LCSW licensure.
Effective supervision requires knowledge of the principles of supervision and the ability to demonstrate necessary skills such as addressing both strengths and challenges of the supervisee, modeling and discussing ethical practice, and providing support and encouragement in the learning context.
What is professional supervision? Professional supervision assists you as a support worker to critically reflect on your work, problem solve, and develop the skills and knowledge to grow your professional competence, confidence, personal resilience and well-being.
What is the breakdown for the experience required to become a LCSW? California law requires 3,000 hours of supervised post-degree professional experience, including 104 supervised weeks, in order to qualify for LCSW licensure.
A supervision contract might include the following areas (adapted from the Social Care Institute for Excellence website). Arrangements for planned one-to-one supervision – including the venue, frequency, duration and what the arrangements are if supervisor/ supervisee has to cancel due to an emergency.
Supervision Hours Next, counselors will apply to the BBS to register as an Associate Professional Clinical Counselor (APCC). An APCC must obtain 3,000 supervised hours over a minimum of two years and a maximum of six years.
License Requirements Education. Master's degree in Social Work from an accredited school of social work. Additional Coursework. Register as an ASW. Fingerprint Requirement. Criminal Background Check. Take and Pass the California Law & Ethics Exam. Accrue Supervised Experience. Take and Pass the ASWB Clinical Exam.

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The Application to Enter into Contract for Supervision toward Licensed Certified Social Worker Status is a formal document that social workers must submit to establish a supervisory relationship with a qualified supervisor as part of the licensure process.
Individuals seeking to become Licensed Certified Social Workers (LCSWs) who need supervision for their practice are required to file this application.
To fill out the application, applicants must provide personal information, details of their intended supervision arrangement, and signatures from both the applicant and the supervisor. It's important to follow any specific instructions provided by the licensing board.
The purpose of the application is to ensure that the applicant is entering into a formal supervision agreement that complies with the requirements set by the state licensing board, facilitating the path to LCSW certification.
The application must report the applicant's identifying information, the supervisor's qualifications and contact information, the scope of supervision, and any other relevant details related to the supervisory relationship.
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