Request a record transfer through the Social Work Registry Complete this form to request a record transfer. "*" indicates required fields Name* First Last Your date of birth* Month Day Year Email* Jurisdiction in which licensure is desired*No selectionAlabamaAlaskaAlbertaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland & LabradorNorth CarolinaNorth DakotaNorth Mariana IslandsNova ScotiaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingDocuments that you are requesting the Registry to send on your behalf: Score report: Associate Score report: Bachelors Score report: Masters Score report: Advanced Generalist Score report: Clinical Have you submitted your application to the desired jurisdiction?* Yes No License verification(s)Please type the state(s) or province(s). TranscriptPlease type school name(s) Supervision (if applicable)Please list supervisor's name. OtherPlease indicate
