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#21-002003-0004
Supplemental Questionnaire

Last Name
First Name
1.

Are you currently licensed as an LMSW in Maryland?  If not, please list when you would be eligible to take the LMSW examination and whether you have scheduled the examination.

2.

Describe your work experience providing forensic social work services.

3.

Describe your experience conducting screening interviews and assessments and developing treatment plans.

4.

Describe your background in Behavioral Health including experience working with clients with co-occurring disorders or other complex behavioral health needs.


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