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The official website of the State of Mississippi


The forms listed here are for social work licensure only. The application packets contain a checklist. Many of these forms may now be submitted via email to or . You can also email us a photo if you have trouble attaching it to an application.

Student Application Packet

Initial Application Packet for NEW Applicants who are NOT licensed in MS

Initial Application Packet for Current MS Licensees UPGRADING from one level to the next

Reciprocity Application Packet for Applicants LICENSED in another state

Universal Recognition Reciprocity Packet for MS Residents LICENSED in another state

Initial Application Form

Verification of Education Form

License Renewal Form 

Continuing Education Report


Field Instructor CE Form

Reinstatement Application Packet

Inactive Status Request Form

Affidavit of Retirement Form

Request for Waiver/Extension of Continuing Education

Application for Contract for LCSW Supervision

4th Evaluation Supervision Packet

Supervision Evaluation Form

Supervisory Documentation Log

Termination of Supervision

Face to Face Client Contact Verification

LCSW Professional Reference Form

LCSW Supervisor Application Packet

Supervisor Evaluation Scale