Official SealDepartment of Budget and Management


#12-001991-001
Supplemental Questionnaire

Last Name
First Name
1.

Do you possess a license as a graduate (LGSW)  or clinical (LCSW-C) social worker from the Maryland Board of Social Work Examiners OR will you be sitting for the exam in the next 90 days?  

Yes No
2.

Please provide your license number and expiration date OR the date you will be sitting for the exam. Not providing this information may result in disqualification.


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