Get Ny Form 4swpr 2020-2025

This guide provides comprehensive instructions on how to complete the NY Form 4SWPR online, ensuring your application for the Licensed Clinical Social Worker Psychotherapy 'R' Privilege is submitted correctly. By following these steps, you can navigate the form with ease and confidence.

Follow the steps to successfully complete the NY Form 4SWPR online.

1. Press the 'Get Form' button to access the NY Form 4SWPR and open it in the editor for completion.
2. In Section I, fill out your personal information. Item 3 requires you to enter your name exactly as it appears on your Application for LCSW Psychotherapy 'R' Privilege (Form 1SWPR). Remember to sign and date item 9.
3. Complete the Social Security Number and Birth Date fields. Leave the Social Security Number blank if you do not possess one. Provide your telephone number and email address, ensuring to clarify if they are personal or professional.
4. Fill out your New York State LCSW license number and the corresponding dates of issuance. Ensure you meet the requirements of 2,400 client contact hours and 36 months of experience.
5. In Section II, your supervisor will need to complete their certification of your supervised experience. Provide them with the entire form and a copy of Appendix A for completion.
6. Once all sections are completed, ensure your supervisor signs the affidavit in Section II. This form must be submitted directly to the Office of the Professions—applications returned by the applicant will not be accepted.
7. Finally, save your changes, then download, print, or share the completed form according to your needs.

Begin your process now by completing your NY Form 4SWPR online.