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LSW Initial Application - Personal Information - State of NV Board of Examiners for Social Workers

LSW Initial Application - Personal Information

While you are in the online application process please do not use the back button in your browser. If at any time you need to make a correction to a prior page or exit the application process, please either click the "Save for Later" or "Exit" button located at the bottom of the page.

License Information

Please select the application type:

Endorsement (Currently licensed as a Social Worker in another state)

Initial by Examination


Are you applying for a Provisional License?	Yes	No

Personal Information

Please provide your present legal name.


First Name	Middle Name	Last Name	Suffix


Do you have any other name(s) ever used?	Yes	No


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Social Security/ITIN Number		Date of Birth	Gender
US Citizen	Race	Preferred Language	Preferred Language Other


Do you identify as indigenous or as a refugee?	Yes	No	N/A

Contact Information


Address (Please include Apt or Suite #)
City	State	ZIP Code	County
Phone Number		Primary Email

Primary Email: The Board will use this email address to communicate with you. This email address will be added to the Board Listserv, which is used to communicate information pertinent to all licensees.