***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 currently licensed as an LCSW-C or LMSW in Maryland? If not, please list when you anticipate being eligible for licensure and what requirements are still outstanding.
2.
Describe your work experience providing forensic social work services including employer name, dates of employment, and job duties. If you do not have this experience please enter N/A.
3.
Describe your experience conducting screening interviews and assessments and developing treatment plans including employer name, dates of employment, and job duties. If you do not have this experience please enter N/A.
4.
Describe your background in Behavioral Health including experience working with clients with substance abuse disorders.
5.
Do you have any drug or alcohol counseling certifications? If so, please specify the certification and date (month/year) received.
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