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Responsibility Statement for Supervisors of an Associate Clinical Social Worker 2018
Supervision to those working toward licensure as a Licensed
Clinical Social Worker to complete and sign, under penalty of perjury, the following statement prior to the
commencement of supervision, and to provide the associate with the original.
Associate’s Name
ASW Number
Supervisor’s Name
As the supervisor:
1)
I am licensed in California and have been so licensed for at least two years prior to commencing this supervision.
(16 CCR §§ 1870(a) and 1874). The license I hold is:
Licensed...
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