D.C. Board of Social Work - New License Application - General Instructions and Sections 1-4

Sep 21, 2026

New License Application materials for the District of Columbia Department of Health, Health Professional Licensing Administration, Board of Social Work. Provide all required sections and original supporting documents, include the required processing fee, and attach additional typed sheets when more space is needed. False or misleading statements can lead to disciplinary action and possible criminal prosecution under DC Code 22-2514. Includes license type selection, payment and mailing information, applicant name and demographic details, address options, preferred mailing address selection, and prior-name documentation requirements.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

General Instructions

Section 1. Type of License

Section 2. Applicant Name/Demographic Information

Section 3A. Home Address

Section 3B. Business Address

Section 3C. Preferred Mailing Address

Section 4. Previous Names

Government of the District of Columbia Department of Health Health Professional Licensing Administration BOARD OF SOCIAL WORK NEW LICENSE APPLICATION GENERAL INSTRUCTIONS All applicants must complete every section of this application and submit the original application and all required supporting documents. The fee must be included for this application to be processed. If more space is needed to fully answer questions, attach additional sheets with typed responses. False or misleading statements will be cause for disciplinary action and could be cause for criminal prosecution pursuant to DC Code 22-2514. If you have any questions, call HPLA Customer Service at 1-877-672-2174, Monday through Friday, 8:30AM to 4:30PM EST. | SECTION 1. TYPE OF LICENSE | | | | | | | | --- | --- | --- | --- | --- | --- | --- | | Please mark the type of license for which you are applying.
Licensed Social Work Associate (LSWA) Examination
Licensed Social Work Associate (LSWA) Endorsement
Licensed Graduate Social Work (LGSW) Examination
Licensed Graduate Social Work (LGSW) Endorsement
Licensed Independent Social Work (LISW) Examination
Licensed Independent Social Work (LISW) Endorsement
Licensed Independent Clinical Social Work (LICSW)
Examination | TOTAL
$230
$230
$230
$230
$230
$230
$230 | Make check or money order payable to DC Treasurer
A charge of $65.00 will be imposed for dishonored checks
(Public Law 89-208) | | | | | | | | MAIL TO: | | | | | | | | D.C. Board of Social Work
P.O. Box 37802
Washington, D.C. 20013 | | | | | | | | | | HPLA ONLY | | | | | | Check $ Check \# Staff | | | | | | Licensed Independent Clinical Social Work (LICSW) $230 Endorsement
Criminal Background Check: For CBC call 877-614-4364 or go online at: Re-Examination (select one) [https://dchealth.dc.gov/node/120532](https://dchealth.dc.gov/node/120532)
LSWA LGSW LISW LICSW $85
$ .00
Duplicate Licenses (limit 5) X $34.00 =
$ .00
Total Enclosed | | $ .00 | | | | | | SECTION 2. APPLICANT NAME/DEMOGRAPHIC INFORMATION | | | | | | | Enter your name exactly as it should appear on the license. If your name has changed at any point since you first attended college or university, you must provide a copy of legal name change document for EACH time that it has changed. Acceptable documents are marriage certificates , divorce decrees or court orders. Complete Section 4 on page 2 of this application. FIRST NAME MI LAST NAME SUFFIX (Jr, Sr, etc. ) M M D D Y Y Y Y SOCIAL SECURITY NUMBER DATE OF BIRTH If applicant does not provide a social security number, a sworn affidavit is required |
PLACE OF BIRTH
Provide City and State for US birthplace or Country for foreign place of birth. | | | | | | | | | Male Female
GENDER
Please check the correct box. | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | SECTION 3A. HOME ADDRESS | | | | | | | | | | | Even if you have a PO Box, a street address should also be provided, if applicable. | | | | | | | | | | | | APARTMENT | | SUITE | | FLOOR | | PO BOX NUMBER | | | |
HOME STREET ADDRESS 1 (If applicable, use this line for additional building information. Otherwise, use this line to indicate STREET NUMBER and STREET NAME) | | | | | | | | | | |
HOME STREET ADDRESS 2 (If additional space is needed, use this line to indicate STREET NUMBER and STREET NAME)

CITY | | | | | | | | | | |
STATE ZIP CODE + 4

HOME PHONE NUMBER HOME FAX NUMBER E-MAIL ADDRESS | | | | | | | | | | GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH– HEALTH PROFESSIONAL LICENSING ADMINISTRATION NEW LICENSE APPLICATION | SECTION 3B. BUSINESS ADDRESS | | | | | | | | | | | | | | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |

FAQs

What must applicants submit with the new license application?

Applicants must complete every section and submit the original application plus all required supporting documents. The processing fee must be included for the application to be processed.

How should applicants choose the type of license they are applying for?

Applicants should mark the license type in Section 1, selecting the appropriate examination or endorsement options for LSWA, LGSW, LISW, or LICSW.

What documents are required if an applicant’s name has changed?

Applicants must provide a copy of legal name change documentation for each change. Acceptable documents include marriage certificates, divorce decrees, and court orders (and related documentation such as a spouse death certificate where indicated).

Sep 21, 2026

Upload by Seraphina