Transcription of STATE OF ARKANSAS SOCIAL WORK LICENSING …
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STATE OF ARKANSAS SOCIAL WORK LICENSING …
LCSW supervision Evaluation Supervisee: _____ License #: _____ Supervisor: _____ License #: _____ Dates of supervision : From: _____ To _____ # of Months: _____ Month/Day/Year Month/Day/Year Average hours spent in weekly supervision : Individual _____ Group _____ Total Individual Hours:_____ Total Group Hours:_____ Overall Direct supervision Hours:_____ Total number of hours worked in a SOCIAL work position during this time period: _____ Evaluate the applicant/supervisee on the following: Unable to Evaluate Poor Average Above Average Superior Practice Skills 1. Ability to assess/understand/access systems 2.
Website: arkansas.gov/swlb LCSW Supervision Evaluation Supervisee: _____ License #: _____ Supervisor: _____ License #: _____
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