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#19-002003-0001
Supplemental Questionnaire

Last Name
First Name
1.

Are you currently licensed as a LMSW or LCSW-C?  If yes, indicate type of license.  If no, indicate N/A.

2.

Please describe your experience working in a forensic social work setting.  Include employer, duties and dates of employment.  If no experience, indicate N/A.

3.

Describe your experience writing social histories.  Include employer, job duties and dates of employment.  If no experience, indicate N/A.

4.

Do you have experience testifying in court?  If yes, please describe your experience.  Indclude employer, duties and dates of employment.  If no, please indicate NA


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