Child Welfare Supervisor (CCWS) Application

Child Welfare Supervisor (CCWS) Application - TACFS
The online CCWS application collects your information to assess initial eligibility for certification. You can complete it in one sitting or save and return later.

A provisional Certified Child Welfare Supervisor (CCWS-P) credential is issued upon submission of a complete application and Employer Attestation of Eligibility, and is valid for 12 months.

During the provisional period, CCWS-Ps must complete training, observation, and case file review requirements using mandatory NCBCWP forms (available online). and submitted for processing as each step is completed. Once all requirements are approved, the CCWS-P is eligible for the exam. The full CCWS credential is awarded upon passing the exam.

Your application is confidential and will not be released except as otherwise indicated within the form.

We look forward to supporting you as you earn your Certified Child Welfare Supervisor professional credential!

Your Personal Information
Title
First Name
As shown on your government issued Identification.
Preferred Name
If you go by a name other than what is on your government issued Identification.
Middle Name
As shown on your government issued Identification.
Last Name
As shown on your government issued Identification.
Suffix
Last 4 of SSN
Phone Number (personal)
Please enter a valid phone number.Format: (000) 000-0000.
Email Address (personal)
example@example.com
Date of Birth

MonthDayYear
Date
Gender
Race
Ethnicity

Mailing Address
Mailing Address (personal)

Street Address

Street Address Line 2

CityState

Zip Code

Code of Ethical and Professional Conduct Agreements
All questions, acknowledgements of understanding, and agreements
are required as a condition of certification eligibility.
The NCBCWP may contact you with questions.
I understand that the NCBCWP’s Code of Ethical and Professional Conduct is posted on the NCBCWP website and it is my responsibility to download, read, understand, and comply with the Code as well as the published Disciplinary Procedures.
I agree to follow the NCBCWP’s Code of Ethical and Professional Conduct and understand that it applies to me immediately, as an applicant and throughout my relationship with the NCBCWP as a current or former credentialed professional.
I understand that if I am the subject of an allegation of ethical misconduct, and the NCBCWP opens an ethical investigation, my credential status will be updated to reflect the open investigation and I am required to submit a formal, written reply within specified timeframes.
I understand that if my eligibility to work with the target population is ever revoked by the state, the NCBCWP will place my credential(s) under inactive status until eligibility is restored and, depending on circumstances, may open an ethics investigation against me.
I further understand that failure to reply to an allegation of ethical misconduct is viewed as an admission of guilt and the investigation and sanctioning procedures will proceed accordingly.
I understand that if I am found to have accessed any confidential databases for any unofficial or otherwise non-work related reasons, to include IMPACT, the Gateway, CLASS or any other official database, the expected discipline is revocation of my child welfare credentials, revocation of any other NCBCWP-issued credentials I may hold, and prohibition to apply for any other NCBCWP credential for a minimum of three (3) years from the date the discipline was enforced.
I understand that if I am found to have falsified any case notes or other information in any child welfare database, to include IMPACT, the Gateway, CLASS or any other official database, the expected discipline is revocation of my child welfare credentials, revocation of any other NCBCWP-issued credentials I may hold, and prohibition to apply for any other NCBCWP credential for a minimum of three (3) years from the date the discipline was enforced.

Formal Education
I attest that I hold an eligible Bachelor’s degree or higher or was granted a degree waiver.
I understand that instead of requesting a second official transcript for certification purposes, my current employer will submit verification to the NCBCWP on my behalf that I have met the Formal Education requirement.
Indicate the highest level of eligible formal education you have completed.
Program of Study/Major
Name of School
City/State

Street Address

Street Address Line 2

CityState

Zip Code
Month and Year of Graduation

MonthDayYear
Date
You are required to provide a minimum of a bachelor's degree and/or transcripts.

Cancelof

Eligible Employment
Employer
Employer Phone Number

Area CodePhone Number
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Date

MonthDayYear
Date
Supervisor Name
Supervisor Email Address
example@example.com
Supervisor Position Title

Assurance and Release
I give my permission to the Board and its staff to investigate my personal and professional background as it relates to this application for professional certification, to include all provided information, statements of understanding, agreements, and associated supporting documents used to determine and verify my eligibility for certification.
I consent to the release of the information contained in my application, to include all supporting documentation and any other pertinent source of information collected by or submitted to the Board in relation to my application to its officers, staff, members of the Board of Directors, and members of Board advisory councils and review committees.
I acknowledge that I have received, read and understand the current NCBCWP certification policies and will abide by such. I understand that this application must be approved by the NCBCWP in its entirety before I will be issued the CCWS in provisional status and that supporting documentation of achievement of training and observation requirements must be approved by the NCBCWP before I am eligible to register for the required examination.
I understand that I am required to earn the full CCWS credential no more than 12 months after holding the CCWS in provisional status. If I fail to earn the full credential in the 12-month period, I may be eligible to request a one-time provisional extension.
I understand that all NCBCWP fees are non-transferable and non-refundable.
Electronic Signature
Full Name
Date

MonthDayYear
Date
Should be Empty:

Child Welfare Supervisor (CCWS) Application - TACFS

Your Personal Information

Mailing Address

Criminal History Information

Code of Ethical and Professional Conduct Agreements

Formal Education

Eligible Employment

Assurance and Release