Louisiana State Board of Social Work
18550 Highland Road, Suite B
Baton Rouge, LA 70809
Phone: 225-756-3470 or 1-800-521-1941 (in LA)
Verification of Licensure, Certification or Registration in
Directions for Applicant:
Complete front portion of form and forward one to each
state/province where you hold or have held a license, certification or
registration to practice social work. You are responsible for all fees relative
to verifying your credential and verifying the requirements you completed
to obtain that credential. Also, submit a copy of the state licensing law to
the Louisiana State Board of Social Work Examiners from each
state/province where license, certification or registration was held.
I am applying for a license, certification or registration to practice social work in
Louisiana based on endorsement. I was granted license, certification or registration #
________ on _____________ by the State/Province of ________________.
The Louisiana State Board of Social Work Examiners requires official verification
directly from the credentialing body that my license, certification or registration in the
State/Province of ___________________ is in good standing.
You are hereby authorized to release any information in your files, favorable or
otherwise, directly to the Louisiana State Board of Social Work Examiners. Your prompt
attention will be appreciated.