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It explains LMSW registration requirements, supervision conditions, and how to confirm a proposed supervisor’s license status before employment. The document specifies applicant and supervisor instructions, required personal and licensing details, and the supervised experience hours and timeline requirements, including a declaration and affidavit.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/social-worker-form-6-plan-for-supervised-experience/328872/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/social-worker-form-6-plan-for-supervised-experience/328872.png","ImageObject",300,407,{"name":92,"@type":93},"Levi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What supervision is required for an LMSW in New York State?","Question",{"text":113,"@type":114},"An LMSW may provide clinical social work services only under supervision of a Licensed Clinical Social Worker, licensed psychologist, or a licensed physician board-certified in psychiatry, in an authorized setting. The setting is responsible for employing the LMSW and the qualified supervisor.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How should the applicant submit the plan and related documents?",{"text":118,"@type":114},"The applicant completes Section I and sends the entire form with a copy of Appendix A to the proposed supervisor for completion of Section II. The completed pages are returned with the $10 fee to the Office of the Professions.",{"name":120,"@type":111,"acceptedAnswer":121},"What are the required supervised experience hours and time period?",{"text":122,"@type":114},"The applicant must complete 2,000 client contact hours of post-MSW supervised experience in diagnosis, psychotherapy, and assessment-based treatment plans. The supervision period must be at least 36 months and no more than 6 years, in an acceptable setting as defined in the regulations.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},328872,1790274075,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52},7971461740909,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","| The University of the State of New York  \u003Cbr>The State Education Department  \u003Cbr>Office of the Professions  \u003Cbr>Division of Professional Licensing Services  \u003Cbr>www.op.nysed.gov   | Social Worker Form 6  \u003Cbr>Plan for Supervised Experience   |\n| --- | --- |\n| Application for Licensed Master Social Worker  \u003Cbr>MI  \u003Cbr>73|$10   |  |\n| A Licensed Master Social Worker (LMSW)must be registered to practice in New York State and may only provide clinical social work services,including  \u003Cbr>psychotherapy,under the supervision of a Licensed Clinical Social Worker(LCSW),licensed psychologist or licensed physician who is board-certified in  \u003Cbr>psychiatry in an authorized seting,as defined in Education Law and Commissioners Regulations.The settingis esponsible for employing the LMSWand the  \u003Cbr>qualified supervisor to provide clinical social work services;a LMSW cannot employ or contract with a supervisor.   |  |\n| Prior to starting your supervised experience,you can veriffy the license status of your proposed supervisor on the Office of the Professions'web site at  \u003Cbr>www.op.nysed.govlopsearches.htm.This form must be submitted prior to being employed or supervised by your proposed superviso.This form will o be  \u003Cbr>reviewed if submitted after the supervised experience has been completed.   |  |\n| Applicant Instructions  \u003Cbr>1.Complete Sectionl.In item 3,enter your name exatly as it appears on your Aplicatin for Licensure (FOrm 1).Be sure to sign and date item 9.Use the  \u003Cbr>psychotherapy log to document your hours of practice and supervision.  \u003Cbr>2.Send the entire form along with a copy of Appendix A to your supervisor and have them complete Sectionll.eturm all pages along with the $10 fee  \u003Cbr>directly to the Office of the Professions at the address at the end of this form.  \u003Cbr>Section l:Applicant Information  \u003Cbr>1.Social Security Number  \u003Cbr>2.Birth Date  \u003Cbr>Month  \u003Cbr>Year  \u003Cbr>Day  \u003Cbr>(Leave this blank if you do not have a U.S.Social Security Number)  \u003Cbr>3.Print Name Last  \u003Cbr>5.Telephone/Email Address  \u003Cbr>First  \u003Cbr>Daytime Phone  \u003Cbr>Middle  \u003Cbr>Home or□Business  \u003Cbr>Licensee business address,phone and email address are public information.Failure to  \u003Cbr>indicate business or home on this form for each item will deem it public information.  \u003Cbr>Area Code  \u003Cbr>Phone  \u003Cbr>4.  Mailing Address□Home or□Business  \u003Cbr>Email Address(please print clearly)  \u003Cbr>(You must notify the Department within 30 days of any address or name changes)  \u003Cbr>□Home or□Business  \u003Cbr>Line 1   |  |\n| Line 2  \u003Cbr>6.New York State DMV ID Number  \u003Cbr>Line 3  \u003Cbr>(Driver or Non-Driver ID)  \u003Cbr>City  \u003Cbr>State  \u003Cbr>ZIP Code  \u003Cbr>(Leave this blank if you do not have a  \u003Cbr>New York State DMV ID Number)  \u003Cbr>Countryl  \u003Cbr>Province   |  |\n| M.S.W.degree date  \u003Cbr>7.New York State LMSW license number  \u003Cbr>mo.day yr.  \u003Cbr>Date LMSW license issued  \u003Cbr>Date registration ends  \u003Cbr>mo.day yr.  \u003Cbr>mo.day yr.   |  |\n| 8.You must complete 2,000 client contact hours of post-MSW supervised experience in diagnosis,psychotherapy and assessment-based  \u003Cbr>treatment plans over a period of at least 36 months and no more than 6 years.You must be supervised by a licensed clinical social  \u003Cbr>worker,licensed psychologist or physician who meets the requirements of section 74.6 of the Commissioner's Regulations in an  \u003Cbr>acceptable setting as defined in section 74.6.  \u003Cbr>Name of proposed supervisor  \u003Cbr>Name of setting   |  |\n| Setting address   |  |\n| 9.I declare and affirm that the statements made in the foregoing application,including accompanying statements are true,complete andd  \u003Cbr>correct I understand that any false or misleading information in,or in connection with my application may be cause for denial oflicensure  \u003Cbr>and may lead to a filing of charges of professional misconduct.  \u003Cbr>Signature   |  |\n| Date   |  |\n| Social Worker Form 6,Page 1 of 2,Revised 1121   |  |\n\n\n| Section II:Supervisor's Verification of Plan for Experience   |  |\n| --- | --- |\n| Instructi","cbCairrq49LZXbML","https://ap.wps.com/l/cbCairrq49LZXbML","pdf",805077,"English","# Section I: Applicant Information\n## Social Security Number and personal details\n## Education and LMSW license information\n## Supervised experience requirements and supervisor names\n## Declaration and signature\n# Section II: Supervisor's Verification of Plan for Experience\n## Supervisor licensing categories and ABPN psychiatry certification\n## Employment setting identification and required attachments\n## Agency and setting details","[{\"question\":\"What supervision is required for an LMSW in New York State?\",\"answer\":\"An LMSW may provide clinical social work services only under supervision of a Licensed Clinical Social Worker, licensed psychologist, or a licensed physician board-certified in psychiatry, in an authorized setting. The setting is responsible for employing the LMSW and the qualified supervisor.\"},{\"question\":\"How should the applicant submit the plan and related documents?\",\"answer\":\"The applicant completes Section I and sends the entire form with a copy of Appendix A to the proposed supervisor for completion of Section II. The completed pages are returned with the $10 fee to the Office of the Professions.\"},{\"question\":\"What are the required supervised experience hours and time period?\",\"answer\":\"The applicant must complete 2,000 client contact hours of post-MSW supervised experience in diagnosis, psychotherapy, and assessment-based treatment plans. The supervision period must be at least 36 months and no more than 6 years, in an acceptable setting as defined in the regulations.\"}]","Social Worker Form 6 - Plan for Supervised Experience | PDF",1789981412]