audit report LCSW-BACS

LOUISIANA STATE BOARD OF SOCIAL WORK EXAMINERS LCSW-BACS CONTINUING EDUCATION AUDIT REPORT July 1, 2009 - June 30, 2010 Name:____________________________________________________________________________________ Address:__________________________________________________________________________________ ____________________________________________________________________________________ Credential No.:__________ Telephone: (_______)_____________________ Fax:_______________________ You must list 20 clock hours of continuing education which includes 10 hours in clinical content covering diag-nosis and treatment, 3 hours in social work ethics and 3 hours in clinical supervision. Ethics and clinical super-vision were to be completed between July 1, 2008 and June 30, 2010. Attach documentation verifying your attendance at the events. Please do not use initials when writing the names of the events or sponsoring organizations. Auditor Use Only Hours Month/Day/Year Hours Approved Not Approved _________ _________ Event: __________________________________________________ _______________ ________ __________________________________________________ Presenter: ________________________________________________________________________ Sponsoring Organization: ...