Blank Supervision Hours Form – Fill Out and Use This PDF

Blank Supervision Hours Form PDF Details

The blank supervision hours form, officially called Form 6, is a mandatory document for applicants seeking licensure as a Licensed Master Social Worker in New York State. The New York State Education Department's Office of the Professions requires this form to verify that an LMSW applicant has completed the required supervised clinical experience before receiving their license.

Who Must Submit This Form

Every LMSW applicant in New York must complete this form before beginning their supervised practice. The supervision must take place under a Licensed Clinical Social Worker, a licensed psychologist, or a licensed physician with board certification in psychiatry. Both the applicant and the supervisor must be employed at the same approved setting.

Social workers pursuing similar credentials may also need a clinical social experience verification form or a supervision agreement to satisfy their licensing board's requirements.

Required Hours and Timeframe

Applicants must complete 2,000 client contact hours over a minimum of 36 months. These hours cover supervised work in diagnosis, psychotherapy, and the development of assessment-based treatment plans. The form must include the supervisor's verification that they meet the qualifications needed to oversee the applicant's practice.

Behavioral analysts documenting their hours may refer to the BCBA annual supervision verification form or the BACB fieldwork supervision form for their specific credential requirements.

What the Form Contains

The four-page form collects personal information about the applicant, the supervisor's license details, the approved practice setting, and an attestation from the supervisor. The applicant must include their New York State LMSW license number, MSW degree date, and the date their LMSW license was issued. Practitioners often use this form alongside a biopsychosocial assessment form to maintain complete clinical documentation.