Temporary License Change Form
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Temp. License Info Compliance Form Change Form Applications

Change in Original Agreement for Temporary License Form:

Temporary Licensees who change employers, DHHR county offices, titles, and/or licensing supervisors must file a Change in Original Agreement for Temporary License Form with the Board.

 

Downloadable / Printable Version of Change in Original Agreement for Temporary License Form:

Get Adobe ReaderChange in Original Agreement for Temporary License Form - Adobe Reader (PDF) Format - 2 pages - 123 KB

 

Completed Change in Original Agreement for Temporary License Forms must be mailed to the Board office:

WV Board of Social Work Examiners
PO Box 5459
Charleston, WV 25361