ACCESSIBILITY: If you are experiencing difficulty with accessing information on this website call 612-617-2100 for assistance.

Forms

Complaint Registration

Complaint Registration Form

CE Providers

CE Providers Application

Applicants

Application Action Steps

Apply for a License Online

Application for Licensure (paper)

360 Clock Hours Forms 1-3 (Submit ONLY with Application for LICSW)

Verification of Licensure Form

ADA Examination Accommodations Application Form

ESL Examination Accommodations Application Form

Apply for Temporary License (online)

Temporary License Application (paper)

Licensees

Apply to Renew Online

Application for Renewal (paper)

Apply to Reactivate an Expired License Online

Application for Expiration from Expiration or Voluntary Termination (paper)

Name Change Form

Supervision

CLINICAL Supervision Plan Form

CLINICAL Supervision Verification Form

NONCLINICAL Supervision Plan Form

NONCLINICAL Supervision Verification Form

Provisional License Forms

Provisional License Application

Provisional License Supervision Plan Form

Provisional License Six Month Evaluation Form

Provisional License Final Evaluation Form

Data Requests

Data Request Form - Data Subject

Data Request Form - Public

Data Request Form - Public Data Mailing List

Professional Firms

Professional Firm Annual Report Form

Professional Firm First Report