**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**
1
Are you approved by the Maryland Board of Social Work Examiners to supervise? If YES, please upload copy of certificate to application.
Yes
No
2
Please describe your supervisory experience, including the number of people under your supervision. In your response, please list employer names, position titles, and dates of employment. If this does not apply to you, enter N/A.
3
Describe your experience providing social work services in an inpatient setting.
Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application. If you do not possess experience in this area, put N/A in the box below.
4
Do you possess a current license as a Certified Social Worker, Clinical (LCSW-C) from the Maryland Board of Social Work Examiners? If yes, please attach your license.
Department of Budget and Management