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Supplemental Questionnaire

Last Name
First Name


***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.***


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.


Describe your work experience providing forensic social work services.


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


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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