Official SealDepartment of Budget and Management

Supplemental Questionnaire

Last Name
First Name

Do you currently possess a license as a Certified Social Worker (LCSW) or Certified Social Worker, Clinical (LCSW-C) by the Maryland State Board of Social Work Examiners?

Yes No

If you answered Yes to the previous question, please provide the license number and expiration date in the box below.  A copy of your current license or license verification should also accompany your application.

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