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#20-002004-0001
Supplemental Questionnaire

Last Name
First Name
1

Are you currently licensed as an LCSW-C in Maryland? If not, please list when you anticipate being eligible for LCSW-C licensure and what requirements are still outstanding. Or indicate when you submitted your application to Maryland Board of Social Work Examiners for out of state approval of your LCSW-C

2

 Describe your work experience providing forensic social work services.

3

 Describe your experience conducting screening interviews and assessments and developing treatment plans.

 
 
4

Describe your background in Behavioral Health including experience working with clients with co-occurring disorders or other complex behavioral health needs.


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