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.

MM slash DD slash YYYY
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

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