[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-331234-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-331234-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","lmsw-supervision-4th-evaluation-checklist-complete-and-submit-packet","LMSW Supervision 4th Evaluation Checklist - Complete and Submit Packet","","LMSW supervision instructions outline the final evaluation period for supervisees and require submission of a supervision packet by email to the Mississippi social work licensing authorities. The packet must include online payment confirmation, application and background check and licensure fees, required forms such as the supervision evaluation, face-to-face client contact verification, termination of supervision, and multiple reference forms. Supervisors complete an evaluation and termination attachment with details of supervision duration, knowledge of professional and ethical behaviors, recommendation status, and supervisor information. After review and approval, an exam approval letter is emailed and fee handling depends on posting to the applicant portal.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/exam/","Exam",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/lmsw-supervision-4th-evaluation-checklist-complete-and-submit-packet/331234/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/lmsw-supervision-4th-evaluation-checklist-complete-and-submit-packet/331234.png","ImageObject",300,407,{"name":42,"@type":43},"Ben Jamin","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-05","2026-09-21",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How should the LMSW supervision packet be submitted?","Question",{"text":63,"@type":64},"The packet is submitted via email to the designated licensing email address. Do not mail items if submitting by email.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What fees must be paid, and when?",{"text":68,"@type":64},"All fees must be paid online through the applicant portal. The $27 application fee is submitted first through the portal, and other fees become available after board staff posts them to the applicant profile.",{"name":70,"@type":61,"acceptedAnswer":71},"Which forms are required for the supervision evaluation process?",{"text":72,"@type":64},"The checklist includes an online initial application, passport-type photo, supervision evaluation form, verification of face-to-face client contact, termination of supervision form, three reference forms, and a request for a fingerprint card form.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},331234,1790619223,{"code":4,"msg":82,"data":83},"success",[84,88,92,95,100,105,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":93,"slug":94},70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},7,"Healthcare",40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":33,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":108,"preview_page_count":4},2336478466772,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","LMSW SUPERVISION 4TH EVALUATION CHECKLIST  \nCongratulations on reaching your last and final supervision period. You may now submit this packet via email to [kdixon@swmft.ms.gov](kdixon@swmft.ms.gov . Please)[ . Please](kdixon@swmft.ms.gov . Please) do not mail anything to us if you submit via email. Once your file is reviewed and approved by the SWDSC, you will be sent an exam approval letter via email.  \nALL FEES MUST BE PAID ONLINE THROUGH THE APPLICANT PORTAL!!  \nSPECIAL PORTAL INSTUCTIONS: Once you submit an application, the portal will take you to the payment screen to submit the $27 application fee. You will not be able to pay for your background check fee or initial licensure fee until Board staff posts the fee to your profile. All fees should be paid through the applicant portal online. All documents can now be submitted via email to [info@swmft.ms.gov](info@swmft.ms.gov . If you)[ . If you](info@swmft.ms.gov . If you) are submitting supervision documents, please email to[kdixon@swmft.ms.gov](kdixon@swmft.ms.gov . Please be)[ . Please be](kdixon@swmft.ms.gov . Please be) sure to read RECENT NEWS and/or Twitter for updates, as well as the Rules and Regulations under RESOURCES.  \nThe documents listed in the checklist below are items you will need to complete the application process. Once all of these items are received, a license will be issued to you. After you pass the ASWB exam, your test score will be forwarded to the Board office within 2 weeks after completing the exam. This step does not automatically upgrade you to LCSW. Your file will be reviewed for approval before you are issued your LCSW license.  \n􀂅 Initial Application (Online Applicant Portal)  \n􀂅 Passport-type Photo  \n􀂅 Processing Fees: $27-Application $50-BG Check $32-Initial Licensure  \n􀂅 Supervision Evaluation Form  \n􀂅 Verification of Face to Face Client Contact Form  \n􀂅 Termination of Supervision Form  \n􀂅 Three Reference Forms (you will need to print 3 copies of this form)  \n􀂅 Request for Fingerprint Card Form-Upon the Board receiving the form, a fingerprint card will be mailed to you.  \nFull legal name of Supervisee   Address    \n_______________________________________  \n_______________________________________  \nWork telephone number    \nSupervisor   LCSW Supervisor No.   Date Completed    \nAttachment C  \nTermination of Supervision  \n\n| General Instructions to supervisors completing this form:\u003Cbr>A. Please complete all items.\u003Cbr>B. The Board assumes that you, in recommending this candidate, will be willing to substantiate to the Board your recommendation, should this Board desire to contact you at a later date.\u003Cbr>I, _____________________________________, licensed certified social worker number ___________, certify\u003Cbr>that I supervised ____________________________ in the field of social work while he/she was employed at________________________, from ____________ to _____________, who worked _______ hours per week. I\u003Cbr>gave ________ hours of supervision per week for a total of ________ hours of supervision (face to face\u003Cbr>_____________ alternate ____________)\u003Cbr>1. Title of Supervisee’s Position: \u003Cbr>2. Supervisee’s duties and responsibilities: \u003Cbr>________________________________________________________________________________\u003Cbr>3. Reason for termination of supervision: \u003Cbr>________________________________________________________________________________ |\n| --- |\n| 4. Extent of knowledge of supervisee’s professional and ethical behaviors:\u003Cbr>􀂉 Limited 􀂉 Moderate 􀂉 Thorough\u003Cbr>5. Please check the appropriate box if supervision has been given for at least two (2) years and the supervisee has completed 100 hours of supervision at one (1) hour per week.\u003Cbr>􀂉 I highly recommend 􀂉 I recommend with reservation\u003Cbr>􀂉 I recommend 􀂉 I do not recommend\u003Cbr>the supervisee for licensed certified social worker. (Attach an explanation if you checked, I recommend with reservation or I do not recommend.)\u003Cbr>6. Please submit a completed evaluation form along with this","cbCaiuLFensLEYAx","https://ap.wps.com/l/cbCaiuLFensLEYAx","pdf",1115413,16,"English","# Submission Instructions\n## Email submission and fee requirements\n# Required Forms and Attachments\n## Initial application items and reference forms\n## Termination of supervision attachment\n# Face-to-Face Client Contact Verification\n## Applicant section and oath/authorization\n## Supervisor or agency documentation\n# Mailing and Contact Information\n## Board of Examiners addresses and form identifiers","[{\"question\":\"How should the LMSW supervision packet be submitted?\",\"answer\":\"The packet is submitted via email to the designated licensing email address. Do not mail items if submitting by email.\"},{\"question\":\"What fees must be paid, and when?\",\"answer\":\"All fees must be paid online through the applicant portal. The $27 application fee is submitted first through the portal, and other fees become available after board staff posts them to the applicant profile.\"},{\"question\":\"Which forms are required for the supervision evaluation process?\",\"answer\":\"The checklist includes an online initial application, passport-type photo, supervision evaluation form, verification of face-to-face client contact, termination of supervision form, three reference forms, and a request for a fingerprint card form.\"}]","LMSW Supervision 4th Evaluation Checklist - Complete and Submit Packet | PDF",1789992336]