NASW-NJ Clinical Supervision Directory Application

Clinical Supervision Directory Application

The NASW-NJ Clinical Supervisor Directory is one of the only referral sources for clinical social work supervisors in New Jersey. This Directory is not maintained by the New Jersey Board of Social Work Examiners or the State of New Jersey. Listing on this Directory is not a recommendation of the supervisor, and implies only that the required coursework was completed.
The Directory is intended as one way in which LSWs may find a qualified clinical supervisor. Each supervisor listed in the NASW-NJ Clinical Supervisor Directory must meet the following criteria:
- Successfully complete a Board approved 20-hour Clinical Supervision Course (the NASW-NJ Clinical Supervision Course is approved by the Board of Social Work Examiners). Clinical Supervision courses which are provided by continuing education sponsors other than NASW-NJ, taken in whole or in combination with NASW-NJ courses, are eligible for the purposes of this Directory.
- Be a Licensed Clinical Social Worker (LCSW) for at least 3 years in “good standing” with the New Jersey State Board of Social Work Examiners at the time. If a supervisor’s license is made inactive or suspended, they must notify us immediately.
- Cost to be listed on the Clinical Supervisor Directory:
  - FREE for NASW-NJ members
- Sign the Statement of Understanding on the Information Application.
If at any point you'd like to be removed from the Clinical Supervisor Directory, please email info.naswnj@socialworkers.org.
Contact Information
NASW Membership ID:*
If not an NASW member, click here.
Name:*
Address (only city will be published)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County:*
Second Address (Optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County:
Preferred Phone Number (will be published)*

Area CodePhone Number
Secondary Phone (Optional) (will be published)

Area CodePhone Number
Email (will be published)*
Social Work License Number (will be published)*
College/Graduate Education
1. School / Degree / Graduation Year*
2. School / Degree / Graduation Year
3. School / Degree / Graduation Year
Clinical Supervision Course Taken

COPY OF YOUR CERTIFICATE IS REQUIRED
Course Date*
Presenter*
Copy of Certificate*

Browse Files

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About Your Practice
Languages Spoken (Other than English)
Areas of Specializations (choose no more than 6)

IndividualsCouplesFamiliesAdolescents Client GroupAdult Client GroupAfrican American Client GroupAsian Client GroupAnxiety DisordersBehavioral DisordersChemical Dependency/AddictionChild Client GroupChild Abuse/Sexual AbuseEarly Childhood DevelopmentEating DisordersFamily ViolenceForensicLGBT Client GroupGeneral Clinical PracticeGeriatric Client GroupHispanic Client GroupHIV/AIDSMarital/DivorceMediationMedical ConditionsMen's IssuesMental Illness/DisordersNative American Client GroupParenting IssuesPhysical DisabilitesPsychoanalysisSexual TraumaSexual DysfunctionsWomen's IssuesOther
Statement of Understanding
Please indicate agreement with a check placed on line next to each item.*

I hereby attest that I am a Licensed Clinical Social Worker (LCSW) and have been for at least three years in good standing with the New Jersey State Board of Social Work Examiners.I have successfully completed an approved 20-hour Clinical Supervision Course that meets the New Jersey State Board requirement, and have provided accurate contact information (updates noted if applicable).I certify that the information contained in this application is true, complete and correct to the best of my knowledge and is made in good faith.I further understand that if any information is later determined to be false, NASW-NJ reserves the right to remove this listing from its directory, with no refund of funds.I further understand that NASW-NJ reserves the right to remove any listing of any person who is found to be in violation of the NASW Code of Ethics, or state social work laws or regulations.I have attached a copy of my clinical supervision certificate (letter of verification) to this application.
Name of Applicant:*
Date*

MonthDayYear
Date
Email
example@example.com
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Should be Empty:

Clinical Supervision Directory Application

Contact Information

College/Graduate Education

Clinical Supervision Course Taken

About Your Practice

Statement of Understanding

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