Below you will find an on-line, printable “application kit” that has everything you need—just print it up by clicking on pieces A and B. Then do the following to complete the process:

1. fill out the brief Application Kit (see A below) and send it in, with fee

a. identify two colleagues who will evaluate your practice, one an advanced clinical social worker and the other an advanced clinical social worker OR psychologist (doctorate) OR psychiatrist (M.D. or D.O.)

b. fill out a brief registration form for each of your colleagues in the Evaluator Packages (see B below)

2. forward the Evaluator Packages to your colleagues, who will complete their evaluations in confidence and forward them to the Board

A. Application Kit & Checklist PDF
B. Evaluator Package PDF