State Licensing Authorization/Confirmation Request Form - University of Kentucky College of Social Work

To request all state confirmations associated with social work licensing, please complete the form below. To ensure that the request can be processed in a timely manner, please ensure that all field are correctly and fully completed.

Name(Required)

First Last

UKID Number (9 digits)

Date of Birth(Required)

Email Address(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other names at time of attendance at UK

Degree Earned at UK(Required)

Graduation Date

Month

–

Year

What type of documentation or verification are you requesting?

Please provide any other information relevant to your request

Attach documentation or forms

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 5 MB, Max. files: 5.

If you have additional questions, please email CoSWVerifications@uky.edu.

NOTE: All requests will be processed within five (5) business days of submission.