TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF SOCIAL WORK

Forms

Titles of Regulations: 18VAC140-20. Regulations Governing the Practice of Social Work.

18VAC140-30. Regulations Governing the Practice of Music Therapy.

Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Department of Health Professions, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, or email erin.barrett@dhp.virginia.gov.

FORMS (18VAC140-20)

Request for Termination of Supervision (rev. 2/2020)

Initial Application for Supervision for LCSW Licensure (rev. 4/2022)

Verification of Clinical Supervision (rev. 4/2022)

Add or Change Supervision (rev. 4/2022)

LCSW Application by Examination (rev. 4/2022)

LCSW Endorsement Online Instructions and Forms (rev. 11/2022)

LMSW Application by Examination (rev. 4/2022)

LMSW Endorsement Online Instructions and Forms (rev. 11/2022)

LBSW Application by Examination (rev. 4/2022)

LBSW Endorsement Online Instructions and Forms (rev. 11/2022)

LCSW Supervision Log (rev. 3/2020)

Application for Reinstatement of Licensure: Checklist Instructions (rev. 3/2020)

Application for Reinstatement Following Disciplinary Action: Checklist Instructions (rev. 3/2020)

Social Work Name/Address Change (rev. 2/2020)

Request for Change in Status of Virginia Social Work License (Current Active to Current Inactive) (rev. 3/2020)

Request for Change in Status of Virginia Social Work License (Current Inactive to Current Active) (rev. 3/2020)

Request for Verification of Virginia Social Work License (rev. 2/2020)

Request for Late Renewal Instructions (rev. 3/2020)

Termination of Supervision (rev. 9/2024)

Initial Application for Supervision for LCSW (rev. 10/2024)

Verification of Clinical Supervision (rev. 9/2024)

Add or Change Supervision (rev. 10/2024)

LCSW Application by Examination (rev. 10/2024)

LCSW Application by Endorsement (rev. 10/2024)

LCSW Reapplication for Licensure by Examination (rev. 10/2024)

LMSW Application by Examination (rev. 10/2024)

LMSW Application by Endorsement (rev. 10/2024)

LBSW Application by Examination (rev. 10/2024)

LBSW Application by Endorsement (rev. 10/2024)

LCSW Supervision Log (rev. 9/2024)

Application for Reinstatement for LCSW (rev. 9/2024)

Application for Reinstatement for LBSW and LMSW (rev. 9/2024)

Application for Reinstatement Following Disciplinary Action (rev. 9/2024)

Change of Name or Address (rev. 10/2025)

Change of Status (Active to Inactive) (rev. 9/2024)

Change of Status (Inactive to Active) (rev. 9/2024)

Verification of Virginia License (rev. 11/2025)

Renewal Application (rev. 9/2024)

Late Renewal Application (rev. 9/2024)

Applicant Out-of-State Verification Form (rev. 9/2024)

Extension Request for Supervised Experience (rev. 9/2024)

Supervisor Approval Application (rev. 10/2024)

Supervisor Out-of-State Verification (rev. 9/2024)

Verification of Education and Field Placement Practicum Hours (rev. 9/2024)

Group Attendance Log (rev. 10/2024)

Prescription Report (rev. 10/2024)

Employer Notification of a Board Order (rev. 10/2024)

Initial Contact for Compliance Monitoring (rev. 10/2024)

Licensee Self-Report Form (rev. 10/2024)

Continuing Education Course Approval Request (rev. 10/2024)

Evaluator Approval Request (rev. 10/2024)

Therapist Approval Request (rev. 10/2024)

Practice Supervisor Report Form (rev. 10/2024)

Request for Board Approval of Practice Supervisor (rev. 10/2024)

Initial Therapy Compliance Report (rev. 10/2024)

Quarterly Report for Therapy Compliance (rev. 10/2024)

Continuing Education Summary Form (rev. 6/2025)

FORMS (18VAC140-30)

Application for Licensure in Music Therapy (eff. 11/2025)

Change of Status (Active to Inactive) (eff. 11/2025)

Change of Status (Inactive to Active) (eff. 11/2025)

Application for Reinstatement in Music Therapy (eff. 11/2025)

Application for Reinstatement Following Discipline in Music Therapy (eff. 11/2025)