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***FOR OFFICE USE ONLY*** - Rhode Island

Rhode IslandBoard of Social Work ExaminersRoom 1043 Capitol Hill Providence, RI 02908-5097 Instructions and Application ForLicense As APhone: (401) 222-2828 Fax: (401) 222-1272 TTY/TDD: (800) 745-5555 Endorsement ExaminationLicensed Independent ClinicalSocial Worker (LICSW) - (Clinical Exam)Licensed Clinical Social Worker (LCSW) - (Masters Exam)**FOR OFFICE USE ONLY**Receipt #:Application Approved:License Number:Issue Date:Signature of Board AdministratorID#:Board Member SignaturesRevised 09/17/2019 jcp**FOR OFFICE USE ONLY** Social Worker ChecklistEndorsement ExaminationApp. & Fee Date:_____ Check_____Photo IDTranscriptExam Results from ASWBLic.

Rhode Island. Board of Social Work Examiners. Room 104. 3 Capitol Hill Providence, RI 02908-5097. Instructions and Application For. License As A. Phone: (401) 222-2828

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