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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 Accomodations Application Form

ESL Examination Accomodations Application Form

Apply for Temporary License (online)

Temporary License Application (paper)

Change in Background Check Requirements

• Effective November 28, 2017 all applicants for initial licensure must submit to a fingerprint-based background check under Minnesota Statutes, Chapter 217.075.
• If your application for intial licensure was received by the Board before November 28, 2017, you are required to submit to a MN BCA Criminal Background Check.  To obtain the MN BCA authorization form please email the Board Office at social.work@state.mn.us and provide your full name.  The form will be sent to you via email.  

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

Professional Firms

Professional Firm Annual Report Form

Professional Firm First Report