Name: ___________________________________ Date: __________________________
Qualified Social Worker – See Validity Period Below
Yes No
1. Hold a Licensed Masters Social Worker (LMSW) issued under R.S.
37:2701 et seq; and
2. Hold Certificate as a Graduate Social Worker (GSW), in
accordance with R.S. 37:201et seq.; receive a minimum of
one hour per week of supervision by a LCSW, if providing
clinical social work services; and have work experience in
one or more of the following social work practice settings
within the past five years:
a) school setting;
b) mental health setting;
c) correction setting;
d) family/child/community service agency;
e) medical social services in which social services were
delivered to families and children;
f) private clinical practice in which social work services were delivered to
adults, children, and families; or
g) have graduate Social Worker field experience in the above Social Work
practice settings plus two years of work experience, to be judged by the
Louisiana State Board of Certified Social Work Examiners.
Validity Guidelines
3. This certificate is valid provided the holder maintains current Louisiana
licensure as a Social Worker and completes a minimum of 20 Continuing
Professional Development/Education Units (CEUs) each year of the validity
of this certificate. Of the 20 CEUs, 10 hours must be related to the
provision of school social work cervices and/or services to children. These
CEUs will remain on file at the employing system.
If you have completed the requirements as listed above and wish to receive a formal evaluation for the purpose of
obtaining additional certification, you must send your official transcript(s) with a completed Ancillary Application
Packet to the Louisiana Department of Education, Division of Certification, Preparation, and Recruitment. If you
have any questions concerning this procedure, you may call 1-877-453-2721.
For use by the Louisiana Employing Agency:
________________________________________ __________________
Signature of Employing Superintendent Date
____________________________________________ ____________________
Signature of Human Resource Director Date
For use by the Certification and Preparation Office only:
__________________________________ ________________
Signature of Evaluating Specialist Date
Revised 1/31/12