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LICENSED CLINICAL SOCIAL WORKER IN-STATE - California

(BBS STATE OF California - BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY Gavin Newsom, Governor Board of Behavioral Sciences 1625 North Market Blvd., Suite S200, Sacramento, CA 95834 Telephone: (916) 574-7830 LICENSED CLINICAL SOCIAL WORKER IN-STATE APPLICATION FOR LICENSURE For Applicants who hold a California Associate Registration* Dear Applicant: Thank you for your interest in becoming a California LICENSED CLINICAL SOCIAL WORKER (LCSW). Included in this packet are the following forms and documents: 1. Application Instructions 2. Important Information for Applicants 3.)

W-2 statement does not match the name of your employer as stated on your verification of experience, an explanation is required. If you are submitting a 1099 form, an explanation is required. VOLUNTEER LETTER: If you volunteered while gaining hours, attach a copy of the letter from your employer verifying your voluntary status on

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