ࡱ> RTMNOPQ'` mbjbjLULU d.?.?p0 TTT(t,vC.ܠp4v$5''''E' g5 B$Eh HCTIIIC ]0CGGGIB RT'GI'GGm 2"T,Р 8 $lFC0vCDH)H,HT,GIIICCIIIvCIIII 0C Application Instructions for Registration as a Registered Social Worker This application should be completed by applicants who have completed or are in the last semester of a social work education program from an accredited or approved social work program. If you are unsure whether your program meets these requirements, please contact the ACSW office at (780)421-1167 in Edmonton, or phone toll-free from anywhere in Alberta at 1-800-661-3089. You may prefer to e-mail the ACSW at acsw@acsw.ab.ca. These instructions will help you to identify and complete the forms you require for your registration. To ensure prompt registration, please read the instructions and ensure that you submit all the required documentation. ACSW will process your application as quickly as possible once all materials have been received. Step 1: All applicants for registration must complete and sign the Application for Registration as a Registered Social Worker. Print all information clearly and legibly. Your responses to the questions in Section 1 of the Application Form will determine which of the following appendices you will need to complete. Appendix A Instructions and application (New/recent graduate) Yellow Appendix B Instructions and application (Regulated in another jurisdiction) Blue Appendix C Instructions and application (Reinstatement with ACSW) Green Appendix D Instructions and application (Experienced and never registered) Orange Appendix E Instructions and application (Member of another profession) Buff Section 1: Personal Information Under the Health Professions Act (HPA), the Alberta College of Social Workers (ACSW) is required to have this personal information on file. It is important to note that your name, as it appears on the application form, will appear in the Register and on your certificate/practice permit. This should be the same name that you are using in practice. If any of your personal information changes after you get registered you must notify the ACSW. Section 2: Practice history This section also asks several questions about your practice and registration history. Please answer ALL questions in this section. If you respond yes to Question 1 (new/recent graduate) you need to: complete Appendix A provide official transcripts supporting your diploma/degree arrange for people to provide one Character Reference and one Supervisor Reference and give them the appropriate forms to submit directly to ACSW. NOTE: these need to be two separate individuals. After you get registered, you will need to practice under the supervision of a Registered Social Worker until you have completed 1500 total practice hours, including those in an approved practicum during your social work education. If you responded yes to Question 2 (Registered/Licensed Social Worker in another jurisdiction) you need to: complete the top of Appendix B for each jurisdiction where you have ever practiced social work Registration will not be complete until verification of your status in the other jurisdiction(s) is received. Refer to the instructions on Appendix B for specific details. If you responded yes to Question 3 (reinstating with ACSW) you need to: complete Appendix C arrange for people to provide one Character Reference and one Supervisor Reference and give them the appropriate forms to submit directly to ACSW. NOTE: these need to be two separate individuals. meet other requirements based on circumstances in additional to the annual dues, submit the reinstatement fee of $125.00 Refer to the instructions on Appendix C for specific details. If you responded yes to Question 4, (experienced and not registered or in school in the past 3 years) you need to: complete Appendix D arrange for people to provide one Character Reference and one Supervisor Reference and give them the appropriate forms to submit directly to ACSW. NOTE: these need to be two separate individuals. pass the social work examination appropriate to your highest level of social work education After you get registered, you will need to practice under the supervision of a Registered Social Worker until you have completed 1500 total practice hours. If you responded yes to Question 5 (registered in another profession) you need to complete Appendix E. See Appendix E for specific details. If you responded yes to Question 6 (Restricted Activities) complete the Application for Authorization to Perform Restricted Activities, found on the ACSW web site. Please note: Only social workers with a BSW or higher degree and who have appropriate education/training and supervised experience are normally authorized to perform psychosocial interventions without supervision. The application for Restricted Activities and Frequently Asked Questions are available at the ACSW office or on-line at www.acsw.ab.ca. Section 2: Education Information To qualify for registration as a Registered Social Worker with the Alberta College of Social Workers, you must have a degree or diploma from a recognized social work program. ACSW requires transcripts supporting your highest level of social work education from an approved social work program. Applicants must arrange to have official transcripts submitted directly to the ACSW office by the educational institution. Transcripts provided by the applicant will not be accepted for purposes of registration. The transcripts must indicate that the applicant has completed the social work program. Applicants with an off-shore social work degree may qualify for registration; however, your transcripts need to be assessed. The assessment must indicate that the credentials are equal to or greater than an approved Canadian program. If you are applying for an assessment by the International Qualifications Assessment Service (IQAS), you must complete the Description of Course Work application. Please ask IQAS to send a copy of the assessment directly to ACSW. Assessment services are provided by: International Qualifications Assessment Service Ministry of Learning, Government of Alberta 9th Floor-9942 108 Street NW Edmonton, Alberta T5K 2J5 Telephone: (780)427-2655 Fax: (780)422-9734 Website: www.learning.gov.ab.ca/iqasCanadian Association of Social Workers 402-383 Parkdale Avenue Ottawa, Ontario K1Y 4R4 Telephone: (613)729-6668 Fax: (613)729-9608 E-Mail: casw@casw-acts.ca Section 3: Employment Information The HPA requires the ACSW to maintain current information on the employment of each Registered Social Worker. Please complete this section if you are currently practicing within the scope of social work (paid employment or volunteer/unpaid work). If you have more than one employer, please include a separate sheet with the additional employers information. Please choose the single best option for both Type of Employer and Primary Field of Practice for each social work position. If you work within the scope of social work practice, you must include evidence of having professional liability insurance coverage. Insurance provided through your employer is acceptable. Please note that any person doing private practice or contract work in addition to paid employment must provide proof of personal coverage. Section 4: Professional Declaration Answer each of the questions. If you answer yes to any question, attach a separate sheet with an explanation for the yes response. Sign and date the application. An unsigned application will not be processed. STEP 2: Complete the appendix(es) that applies to your specific circumstances. Each Appendix has specific instructions. Please read these instructions carefully and respond accordingly. STEP 3: Arrange for your supporting documentation to be forwarded to the Alberta College of Social Workers. Note: Registration is not processed until all supporting documentation and fees are received and all requirements are met. It is the responsibility of the Applicant to ensure that all supporting documentation is received by the Registrar. The ACSW will notify you once only of any missing documents, normally within 30 days of receiving the completed application form and fees. If your application is not complete within six months from the date of the letter, your application will be considered abandoned and will be destroyed. All applicants must submit the following documents: A detailed current rsum. This should include dates and location of any social work related employment, academic credentials, continuing education activities, etc. A current (within 3 months) Criminal Record Check. See below for details. Proof of professional liability insurance if you are working. Insurance coverage may be through your employer, however, all social workers doing private practice or contracted services must carry personal liability insurance. If you are not yet employed, proof of insurance must be submitted when you begin working. Transcripts supporting your highest social work education program. Criminal Record Check Information The submission of a current Criminal Record Check (CRC) is one of the requirements for registration as a Registered Social Worker. Call your local law enforcement detachment and find out when the CRCs are performed, where you have to go, what the fee will be, and what identification is required. You will be required to produce the appropriate identification which may include: drivers license, passport, social insurance card, birth certificate, Canadian citizenship card. (Identification with your photograph, date of birth and signature may be required.) Be prepared for fingerprint verification, if requested. You will be responsible for paying the fee for this check. A criminal record check must be current, not more than three months from the date of application. Fee Schedule Fees are set in three categories. If you are receiving pay for work that falls within the scope of social work practice, the fee is $350. If you are not receiving pay for work that falls within the scope of social work practice, the fee is $175. If you are a student member (only) and not registered, the fee is $75. (The Student Membership Application has further information.) The ACSW year is divided into four quarters. If your registration is issued between January 1 and March 31, your expiry date will be December 31. If your registration is issued between April 1 and June 30, your expiry date will be March 31. If your registration is issued between July 1 and September 30, your expiry date will be June 30. If your registration is issued between October 1 and December 31, your expiry date will be September 30. (This does not apply to student members. A student members renewal date is established when they join the ACSW. Contact the ACSW office if you are making application for registration and are a student member with the ACSW.) Renewals are due one month before your registration expires. Registration Fees (Only Active RSWs will receive a practice permit.) Working within the scope of social work practice - Employed/Receiving Income for social work $350.00 - Working as a volunteer or in an unpaid position $175.00 Not working within the scope of social work practice - Inactive Registered Member/Retired Registered Member $175.00 Registered Student Member - Employed/Receiving Income for social work $350.00 - Receiving no pay for social work $175.00 Payment Information and Options Please submit this form with your application. Name: __________________________________________________________ Application Fee: (select one) _____ $80.00 I am a first-time applicant for registration with the ACSW. _____ $125.00 I am reinstating my registration with the ACSW after cancellation by ACSW. _____ $50.00 I am reinstating my registration with the ACSW after requesting cancellation. Professional Dues: (select one) _____ $350.00 I am receiving income for work that falls within the scope of social work practice. _____ $350.00 I am actively seeking employment that falls within the scope of social work practice. _____ $350.00 I am a registering as a student employed (and receiving income) within the scope of social work practice. _____ $175.00 I am working as a volunteer or in an unpaid position that falls within the scope of social work practice. _____ $175.00 I am registering as a student who is not receiving income for work that falls within the scope of social work practice. I will not receive a practice permit. _____ $175.00 I am applying for registration but do not plan to work within the scope of social work practice at present, and I will not receive a practice permit. _____ _______ *I am currently a student member of the ACSW and am now applying for registration. (*Call the ACSW office to determine your prorated fee.)  Total Payment Enclosed: $  _____ My cheque made payable to the Alberta College of Social Workers for the total payment is enclosed. _____ My money order made payable to the Alberta College of Social Workers for the total payment is enclosed. _____ I authorize payment be charged to my Visa/MasterCard as required. Visa/MasterCard ____________/____________/____________/____________ Expiry Date _______/________ Signature on Card ___________________________________________________________________________ Name on Card (please print) ___________________________________________________________________ A receipt for income tax purposes will be issued when Registration is processed. The Alberta College of Social Workers will accept cash, money orders, personal cheques and Visa or MasterCard. Full payment for the application fee and professional dues must accompany the Application for registration as a Registered Social Worker. Only social workers who are actively engaged within the scope of social work practice will receive a practice permit upon completion of the registration process. To ensure that a permit is sent to you, please complete this information and return it to this office. If you are applying for student membership only, please only submit the Student Membership Form. Application for Registration as a Registered Social Worker in Alberta SECTION 1: Personal information (please print legibly) Ms (Miss (Mrs (Mr (Dr (Name*FirstMiddleLastPreferredHome AddressCity/TownProvincePostal CodeTelephone( )Telephone 2( )Primary E-Mail**Gender( Female ( MaleDate of Birth(mm/dd/yyyy) _______/________/__________* The name, as stated, will be recorded in the Register and will appear on your certificates. This should be the same name you use in your social work practice. ** ACSW provides regular communication to members via e-mail. The e-mail listed here should be the one you prefer us to use. Please note that some information is only provided by e-mail. SECTION 2: Practice/registration history Please answer all the following questions. You may need to complete more than one appendix; please read carefully. 1. Are you a new or recent (within the past 3 years) graduate from a social work education program getting registered for the first time? ( Yes ( No If yes, please complete Appendix A. Are you now or have you ever been registered, licensed or certified as a social worker in another jurisdiction? ( Yes ( No If yes, please complete Appendix B. Are you applying for reinstatement with ACSW? ( Yes ( No If yes, please complete Appendix C. Are you an experienced social worker who has not been registered, licensed, or certified in any jurisdiction or attending a social work education program within the past 3 years? ( Yes ( No If yes, please complete Appendix D. If yes, you must register for and pass the examination appropriate to your highest level of social work education. Please submit your application with the application fee and all documentation except the supervisor reference form. You will be notified when you can register for the exam. Information about the exams can be found at  HYPERLINK "www.aswb.org" www.aswb.org. You may be eligible for registration as a provisional social worker until you have passed the exam and completed 1500 practice hours under the supervision of an RSW. Are you now or have you ever been registered, licensed, chartered or certified with another health profession? ( Yes ( No If yes, which profession? ___________________________ If yes, please complete Appendix E. Are you requesting authorization to perform psychosocial interventions without supervision? ( Yes ( No If yes, please complete the Application for Authorization for Restricted Activities (available at HYPERLINK "http://www.acsw.ab.ca"www.acsw.ab.ca). SECTION 3: Education information List your post-secondary academic credentials (must include an approved diploma/degree in social work) Diploma/Degree Granted Specialization (if applicable) Post-Secondary Institution Year of GraduationEducational Transcripts: If this is your first time applying for registration, licensing or certification as a social worker, please ensure that official sealed transcripts are forwarded from the educational institution(s) directly to the Registrar of the ACSW. (See Application Instructions) If you have been registered, licensed or certified by another social work regulatory body, official transcripts may not be required. (See Appendix B Instructions) SECTION 4: Employment information (If you have more than one social work job please complete additional pages as necessary.) Job TitleEmployerWork addressCity/TownProvincePostal CodeTelephone( )Telephone 2( )E-mailFax( )Employment Status( Full-time ( Part-time (hrs/wk ________) ( Casual ( Other __________________Date Employment CommencedYear Month Day 1. Type of Employer (choose one best fit) ( Aboriginal Government ( Alberta Health Services ( Non-Profit Agency ( Child & Family Authority ( Other health provider ( For Profit Agency ( Human Resources & Employment ( Municipal Govt/FCSS ( Post-Secondary Ed ( PDD ( Federal Government ( Private Practice/Contract Services ( Other Provincial Govt Dept ( School/School Board ( Other (specify)____________________ What is your current primary field of practice? ( Addictions ( Criminal Justice ( Medical ( Research ( Admin/Management ( EAP/Occupational SW ( Mental Health ( School SW/FSLW ( Adoptions ( Family Violence ( Organizational Consulting ( Settlement Services ( Child Welfare ( Gerontology ( Policy/Planning ( Teaching ( Clinical ( Home Care ( Rehabilitation ( Youth work ( Community ( Mediation ( Other (specify)_______________________________ SECTION 5: Professional declaration (complete in full) If you answer (YES( to any of the following, please attach a separate sheet with an explanation. A positive response to any of these questions will not automatically disqualify an applicant from registration. ( YES ( NO (a) Have you ever been suspended, placed on probation, expelled, or requested to resign from any social work education program in which you were enrolled? ( YES ( NO (b) Have you applied for and been denied a license, certificate or registration in any behavioral health profession? ( YES ( NO (c) Have you had any disciplinary action taken against you by the authority issuing the license, certificate or registration in any profession in Alberta or any other jurisdiction? ( YES ( NO (d) Have you surrendered or cancelled your license, certificate or registration in lieu of disciplinary proceedings by the issuing authority of any profession in Alberta or any other jurisdiction? ( YES ( NO (e) To your knowledge, have any unresolved or pending complaints ever been filed against you with any profession in Alberta or any other jurisdiction? ( YES ( NO (f) Have you been disciplined by a social work or other professional association? ( YES ( NO (g) Have you been convicted or pled guilty to a criminal offense, other than a minor traffic violation? ( YES ( NO (h) Have you been named as a defendant in a malpractice suit, entered into a settlement agreement or paid court awarded damages, or is there such a suit pending? ( YES ( NO (i) Have you in the past five years or do you currently have any condition, including mental or emotional condition, alcohol or other substance abuse, or any other condition that may impair your ability to competently and safely practice as a social worker? ( YES ( NO (j) Have you been involuntarily terminated (includes resigning in place of disciplinary action) from any behavioral health or related employment for unprofessional conduct? I hereby declare that the information provided in this application is complete and accurate. ________________________________ ______________________________________________________ Date Signature Please note: If an applicant is found to have concealed or made a misrepresentation regarding previous disciplinary sanctions or to have provided false information on the application form, this may be considered prima facie evidence bearing on the applicant(s character and reputation. An incomplete application form will not be processed. APPENDIX A Application instructions for new/recent graduate registration Appendix A should be completed by applicants who have completed a social work education program from a CASWE or CSWE accredited university or from an approved Alberta social work diploma program within the past 3 years. Upon receipt of the completed application form and appropriate fee, a file will be opened. A Provisional Registered Social Worker practice permit will be issued when the ACSW receives all supporting documentation other than the verification of 1500 hours of supervised practice and the Supervisor Reference form. It is the responsibility of the applicant to ensure that all supporting documentation is received by the Registrar. If you have not read the Application Instructions and completed the Application for Registration as a Registered Social Worker do so now. Review the Application Instructions to ensure that you have provided all the necessary information and documentation. Education qualifications. Applicants must arrange to have official transcripts from your highest level of social work education submitted directly from the institution to the ACSW office. Transcripts provided by the applicant will not be accepted for purposes of registration. Because transcripts must indicate that you have completed the social work program, you may submit a copy of a letter issued by the educational institution that states you have completed your social work program as proof of qualification until your transcripts are complete. Official transcripts must be submitted before Provisional Registration will be lifted. Background Information. Please provide a current rsum. ACSW is most interested in social work related activities and provinces of residence. Supervised Practice Hours. New registrants will be provisionally registered until they have satisfactorily completed 1500 hours of social work practice, supervised by a qualified social worker. Successfully completed practicum hours will count toward the 1500 hours if the practicum was supervised by an RSW. A qualified social worker is registered, licensed, or certified in the jurisdiction in which she/he practices. The social worker will be considered qualified if she/he was registered during the period of supervision. Employment (paid or volunteer) hours worked prior to registration will not count toward the 1500 required hours. References. The Supervisor Reference Form must be completed by a Registered Social Worker who has supervised you for at least 350 of the last 500 provisional hours; hold onto it until all hours have been completed. The Character Reference Form may be given to a person of your choice who is able to answer the questions and who is not a family member/partner. Please write the referees name and address in the space at the top of the form. Ensure that your name appears on the form. Ask your referees to submit the forms directly to the ACSW office. Current Criminal Record Check. Refer to the Criminal Record Check Information for details on where and how to have a criminal record check completed. Insurance. All social workers are who are working within the scope of social work practice are required to show evidence of having professional liability insurance. This may be coverage through your employer, or you may have a personal policy through the ACSW group plan or another company. A copy of the cover sheet showing who is covered for what is sufficient. If you are not currently in practice, you must forward this documentation when you begin working. Restricted Activities. Social workers with a BSW or higher degree and who have appropriate education/training may be authorized to perform psychosocial interventions without supervision. Information on psychosocial interventions is available on the ACSW website at www.acsw.ab.ca, as is the application form. Please complete the other side of this page (Appendix A) and submit it with your application. When you have completed the 1500 provisional hours, please ensure the Supervisor Reference Form is submitted to complete your application. Please confirm that all other documentation has been received at this time. Provisional registration will not normally be granted beyond the first year of registration. If you are unable to complete the 1500 hours within one year, please contact the ACSW office. NOTE: Your registration will remain provisional until your official transcript is received. APPENDIX A New/recent graduate Name of Applicant: ___________________________________________________________________ For each practicum placement completed as part of your social work education, please provide the following: First Placement: Agency/organization: _________________________________________________________________________ Agency/organization address: _________________________________________________________________ ___________________________________________________________________________________________ Supervisors Name: ______________________________________ Phone: (_____)____________________ Is this supervisor a Registered Social Worker? ( Yes ( No If yes, where? _____________________________ Dates of Placement: _____/____________/________ to _____/____________/________ Total Hours: ________ Year Month Day Year Month Day Second Placement: Agency/organization: _________________________________________________________________________ Agency/organization address: _________________________________________________________________ ___________________________________________________________________________________________ Supervisors Name: ______________________________________ Phone: (_____)____________________ Is this supervisor a Registered Social Worker? ( Yes ( No If yes, where? _____________________________ Dates of Placement: _____/____________/________ to _____/____________/________ Total Hours: ________ Year Month Day Year Month Day Third Placement: Agency/organization: _________________________________________________________________________ Agency/organization address: _________________________________________________________________ ___________________________________________________________________________________________ Supervisors Name: ______________________________________ Phone: (_____)____________________ Is this supervisor a Registered Social Worker? ( Yes ( No If yes, where? _____________________________ Dates of Placement: _____/____________/________ to _____/____________/________ Total Hours: ________ Year Month Day Year Month Day Note: If you completed more than three social work practicum placements, please add pages as necessary. APPENDIX B Application instructions for social worker registered/licensed in another jurisdiction Any social worker who is or has ever been registered, certified or licensed to practice social work in another jurisdiction must complete the consent form (top part of Appendix B) to enable us to obtain the documentation we require for our files. A separate form must be completed for each jurisdiction where you have practiced social work. You may copy this form or obtain additional copies from the ACSW office or web site,  HYPERLINK "www.acsw.ab.ca" www.acsw.ab.ca. Under the Health Professions Act, social workers who are/have been registered, certified or licensed to practice social work within the past three years are eligible to apply for registration through reciprocity, without having to re-establish their credentials. Currently the ACSW recognizes the regulatory boards in all Canadian provinces and the licensing boards in the United States that are members of the Association of Social Work Boards. If the verification form indicates that the issuing board has an original copy of your transcript from an accredited social work degree program, we do not require a transcript. Nor do we require references. If the verification form indicates that you have passed the Clinical Social Work Examination and you have been practicing as a clinical social worker for at least 1000 hours in the past five years, you may also qualify to be on the Clinical Specialty Registry in Alberta. There is an additional $50 fee to be on this registry. Only members of the Clinical Specialty Registry may use the title Clinical Social Worker in Alberta. If it has been more than three years since you were registered, registration through reciprocity is not available. You must pass the social work examination appropriate to your highest level of social work education in order to become registered. Please also complete Appendix D. You will be notified when you can register for the exam. Information about the social work exams can be found at  HYPERLINK "www.aswb.org" www.aswb.org. If you have not read the Application Instructions and completed the Application for Registration as a Registered Social Worker do so now. Review the Application Instructions to ensure that you have provided all the necessary information and documentation. Current Criminal Record Check. A current Criminal Record Check, completed within three months of the date of application, is a requirement for registration. (See Criminal Record Check instructions for further information.) Background Information. Please provide a copy of your rsum, indicating your social work practice history, locations of practice, and continuing competence activities over the past five (5) years. Insurance. All social workers are required to show evidence of having professional liability insurance. This may be through coverage by your employer, or you may have a personal policy through the ACSW group plan or through another company. A copy of the cover sheet showing who is covered for what is sufficient. If you are not currently in practice, please forward this documentation when you begin working. Restricted Activities. Social workers with a BSW or higher degree and who have appropriate education/ training may be authorized to perform psychosocial interventions without supervision. If you plan to work in a mental health position, please complete the Application for Authorization for Restricted Activities. Please complete the top half of Appendix B (the other side of this page) and send it to the relevant social work board(s). Note: Some regulatory bodies require a fee for verification. The applicant is responsible for any additional fees. Please check with the jurisdiction(s) you are coming from and include any additional fees required when you send them this form. Please send a copy of this form to the ACSW office as well for our records. It is your responsibility to see that all other documentation is received in the ACSW office. Upon receipt of the completed application, supporting documentation and fees, a provisional practice permit will be issued. Once verification has been received from the previous regulatory board, and you have passed the examination (if required), you will receive a permanent wall certificate and a practice permit. APPENDIX B Alberta College of Social Workers 550-10707 100 Avenue NW Edmonton, AB Canada T5J 3M1 Verification of Registration/Licensure Applicant: Complete the top portion of this form and mail it to the board(s) where you are or have been registered/licensed to practice social work. Please check with the appropriate board and include any required fees with this form. Complete one form for each applicable regulatory body. A copy of this form should also be submitted to ACSW with your application.  Name in Full:Name on Registration/License if different from the above: Date of Birth: Registration/License #:Name of Issuing Board:I am applying for registration in Alberta to practice Social Work. The Alberta College of Social Workers requests that I submit verification of my registration/license/certification status in ________________________. You are hereby authorized to release any information in your files, favourable or otherwise, directly to the Alberta College of Social Workers. Your early attention is appreciated. Signature: ___________________________________________________ Date_________________________  Social Work Board: Please complete and return form directly to the Alberta College of Social Workers (address above). Registration/License/Certificate Information Name in your recordsType of registration/licenseNumberDate first issuedDate ExpiredIs the registration/license/certificate current?( Yes ( NoIf yes, expiration dateLevel of exam taken (if any)Date passed Education information Do you have original transcripts for this individual showing a BSW ( MSW ( PhD/DSW (If not, on what basis was this individual registered/licensed? ( Grandparented ( Reciprocity - with which jurisdiction _________________ ( Other - please explain: To your knowledge, did the applicant graduate from a program accredited by CASSW/CASWE or CSWE? ( Yes ( No Registration/License history Do you consider this individual to be in good standing at this time? ( Yes ( No If no, please explain: Are there any restrictions on this individuals registration/license? ( Yes ( No If yes, please explain: According to your records, have there ever been any Complaints and/or Disciplinary Actions against this individual? ( Yes ( No If yes, please explain: Is there any other information the Alberta College of Social Workers should be aware of with regard to this individual that you can share? ( Yes ( No If yes, please explain: Is there any other information the Alberta College of Social Workers should be aware of with regard to this individual that you cannot share? ( Yes ( No If yes, please explain:  Form Completed By Name (please print)DateTitleSignature APPENDIX C Application instructions for social workers reinstating with ACSW Appendix C should be completed by all applicants who were previously registered with the Alberta College of Social Workers except those who have been practicing and registered/licensed in another jurisdiction since you were last registered in Alberta. Upon receipt of the completed application form and appropriate fee a file will be opened. All other documentation must be received and all requirements met before registration will be complete. It is the responsibility of the applicant to ensure that all supporting documentation is received by the Registrar. Once all documentation other than the supervisor reference form and the exam score (if required) has been received a provisional practice permit may be issued. If you have not read the Application Instructions and completed the Application for Registration as a Registered Social Worker do so now. Review the Application Instructions to ensure that you have provided all the necessary information and documentation. Background information. Provide a detailed copy of your rsum describing your social work practice history. Education qualifications. Check with the ACSW office to see what transcripts, if any, are currently on file. If you have completed additional social work education since last registered with ACSW please provide transcripts or a copy of your diploma/degree so that our files are up to date. References. The Supervisor Reference Form must be completed by a Registered Social Worker who has supervised you for at least 350 of the last 500 provisional hours; hold onto it until all hours have been completed. The Character Reference Form may be given to a person of your choice who is able to answer the questions and who is not a family member/partner. Please write the referees name and address in the space at the top of the form. Ensure that your name appears on the form. Ask your referees to submit the forms directly to the ACSW office. Criminal record check. A current criminal record check, completed within three months of the date of application, is a requirement for registration. (See Criminal Record Check instructions for further information.) Insurance. All social workers are required to show evidence of having professional liability insurance. This may be through coverage by your employer, or you may have a personal policy through the ACSW group plan or through another company. A copy of the cover sheet showing who is covered for what is sufficient. If you are not currently in practice, you must forward this documentation when you begin working. Restricted activities. Social workers with a BSW or higher degree and who have appropriate education/training may be authorized to perform psychosocial interventions without supervision. Information on psychosocial interventions is available on the ACSW website at www.acsw.ab.ca, as is the application form. Additional requirements. Applicants for reinstatement will have different requirements based on the reasons for prior cancellation and the time since last registered. Some of these will need to be met before the application is approved. Others may be met as a provisional registered social worker. Details are on the reverse. Please note, a request to have registration cancelled must have been received and acknowledged by the ACSW office prior to receiving a cancellation notice from the office. Call to confirm whether your file indicates cancelled at member request. Please complete the other side of this page (Appendix C) and submit it with your application. APPENDIX C Social workers reinstating with ACSW Name: _____________________________________________________________________________ When was your registration with ACSW cancelled? ___________________________________  Did you submit a request for cancellation ( Yes ( No (Confirmation section to be completed by ACSW staff) Have you been practicing social work since your registration was cancelled? ( Yes ( No If yes, please explain why you were not registered:  What were the reasons for cancellation? (Please check all that apply.) Took a break from practice (includes maternity leave, travel, etc.) Moved away from Alberta Returned to post-secondary education Forgot to renew Did not complete the competence program requirements Cancelled following a disciplinary hearing Other please specify _____________________________________________________________________ Please list any social work or related education/training you have completed in the last 3 years: (add pages if necessary or provide complete details in your rsum) Course/programInstitution/providerDates Please complete and submit both a Self Assessment and a Learning Plan for the coming year using one of the formats attached. Examination requirements: Applicants who have not been registered/licensed to practice social work or attending a social work education program within the past three years must pass the ASWB exam appropriate to your highest level of social work education. Diploma in social work Associates Exam BSW Bachelors Exam MSW Masters Exam (This section to be completed by ACSW staff.) Notification of exam date sent on:Examination date:Score: Additional requirements: If your cancellation was due to non-compliance with competence, or if you did not renew when your portfolio was due, you must submit a complete competence portfolio for all the years of practice since your last portfolio was submitted or the past 5 years, whichever is less. In lieu of a portfolio, you may choose to take the examination appropriate to your highest level of social work education. If your registration was cancelled following a disciplinary hearing, please provide evidence of compliance with all conditions listed in the decision of the hearing tribunal. The registration committee may ask for additional information prior to making a decision about reinstatement. APPENDIX D Application instructions for experienced social workers who have never been registered/licensed Appendix D should be completed by applicants who completed a social work education program from a CASWE or CSWE accredited university or from an approved Alberta social work diploma program more than 3 years ago who have never been registered or licensed in any North American jurisdiction. Upon receipt of the completed application form and appropriate fee, a file will be opened. A provisional practice permit may be issued when the ACSW receives all supporting documentation other than the verification of 1500 hours of supervised practice, the Supervisor Reference form, and verification of passing the exam. It is the responsibility of the applicant to ensure that all supporting documentation is received by the Registrar. Provisional registration will remain in place until the applicant has met the examination requirements. If you have not read the Application Instructions and completed the Application for registration as a registered social worker do so now. Review the Application Instructions to ensure that you have provided all the necessary information and documentation. Education qualifications. Applicants must arrange to have official transcripts from your highest level of social work education submitted directly to the ACSW office by the academic institution. Transcripts provided by the applicant will not be accepted for purposes of registration. Examination requirements. All applicants who completed their social work education more than three years ago and who have never been registered/licensed must pass the social work examination appropriate to their highest level of education. Once your application has been processed you will be notified of the date and location where the exam will be held. Please note: There are limited opportunities to take the exam and it may only be offered in one location within a year. It is the applicants responsibility to make arrangements to take the exam as soon as reasonably possible. Background information. Please provide a current rsum. ACSW is most interested in social work related activities and provinces of residence. Supervised practice hours. New registrants will be provisionally registered until they have satisfactorily completed 1500 hours of social work practice, supervised by a registered social worker. Work prior to registration will not count toward the 1500 required hours. References. The Supervisor Reference Form must be completed by a Registered Social Worker who has supervised you for at least 350 of the last 500 provisional hours; hold onto it until all hours have been completed. The Character Reference Form may be given to a person of your choice who is able to answer the questions and who is not a family member/partner. Please write the referees name and address in the space at the top of the form. Ensure that your name appears on the form. Ask your referees to submit the forms directly to the ACSW office. Current criminal record check. Refer to the Criminal Record Check Information for details on where and how to have a criminal record check completed. Insurance. All social workers are who are working within the scope of social work practice are required to show evidence of having professional liability insurance. This may be through coverage by your employer, or you may have a personal policy through the ACSW group plan or through another company. A copy of the cover sheet showing who is covered for what is sufficient. If you are not currently in practice, you must forward this documentation when you begin working. Restricted Activities. Social workers with a BSW or higher degree and who have appropriate education/ training may be authorized to perform psychosocial interventions without supervision. Information on psychosocial interventions is available on the ACSW website at www.acsw.ab.ca, as is the application form. Please complete the other side of this page (Appendix D) and submit it with your application. When you have completed the 1500 provisional hours, please ensure the Supervisor Reference Form is submitted to complete your application. Please confirm that all other documentation has been received at this time. Provisional registration will not normally be granted beyond the first year of registration. If you are unable to complete the 1500 hours within one year of registration, please contact the ACSW office. APPENDIX D Social workers who have never been registered/licensed Name of applicant: ______________________________________________________________________________ Please provide a detailed explanation for why you have never been registered or licensed to practice social work.  Please list any social work or related education/training you have completed in the last 5 years: (add pages if necessary) Course/programInstitution/providerDates Please complete a self assessment and a learning plan for the coming year using one of the formats attached. Examination requirements: Applicants who have not been practicing social work or attending a social work education program within the past three years must pass the ASWB exam appropriate to your highest level of social work education. Diploma in social work Associates Exam BSW Bachelors Exam MSW Masters Exam (This section to be completed by ACSW staff.) Notification of exam date sent on:Examination date:Score: APPENDIX E Verification of Registration/Licensure in Other Profession Applicant: Complete the top portion of this form and send it to the relevant board. Complete one form for each applicable regulatory body. Submit a copy of the completed form with your application for our records. Please check with the appropriate board and include any required fees with this form.  Name in Full:Name of Issuing Professional Organization:Full Address of Profession Organization: Name on Registration/License if different from the above: Date of Birth: Registration/License/Certificate #:I am applying for registration in Alberta to practice Social Work. The Alberta College of Social Workers requests that I submit verification of my registration/license/certification status with ____________________________________________. You are hereby authorized to release any information in your files, favourable or otherwise, directly to the Alberta College of Social Workers. Your early attention is appreciated. Signature: _____________________________________________________ Date_________________________  Professional Board: Please complete and return form directly to the Alberta College of Social Workers (address above). Registration/License/Certificate Information Name in your recordsType of registration/license/certificateNumberDate first issuedDate ExpiredIs the registration/license/certificate current?( Yes ( NoIf yes, expiration date Please turn over ( Registration/License/Certificate history Do you consider this individual to be in good standing at this time? ( Yes ( No If no, please explain: Are there any restrictions on this individual(s registration/license/certificate? ( Yes ( No If yes, please explain: According to your records, have there ever been any Complaints and/or Disciplinary Actions against this individual? ( Yes ( No If yes, please explain: Is there any other information the Alberta College of Social Workers should be aware of with regard to this individual that you can share? ( Yes ( No If yes, please explain: Is there any other information the Alberta College of Social Workers should be aware of with regard to this individual that you cannot share? ( Yes ( No If yes, please explain:  Form Completed By Name (please print)DateTitleSignature Application for Registration as a Registered Social Worker CHARACTER REFERENCE FORM Applicant, please complete this section: Referees NameReferees Address Applicants Name Referee, please complete the remainder of the form: The above named applicant has made an application to become a Registered Social Worker under the Health Professions Act (1999). The Act requires that the candidate for registration must provide evidence of having good character and reputation. Registration in social work is a commitment to skilled and ethical practice. Registered Social Workers are accountable for their practice to the public and to the profession. You have been named as a referee by the applicant. Please answer the following questions: How long have you known the applicant?What is your relationship to the applicant?Have you ever observed the applicant engaged in social work practice? ( Yes ( NoIf yes, please describe the circumstances: In your opinion, is the applicant currently engaged within the scope of social work practice? ( Yes ( NoWhat is the applicant doing? In your opinion, does the applicant possess the personal and professional integrity to practice social work in accordance with the current Social Work Code of Ethics? ( Yes ( NoPlease give examples to support your opinion.How does the applicant demonstrate respect for the client-social worker relationship? How does the applicant demonstrate knowledge regarding current ethical issues in social work practice? Please add additional pages if necessary. To your knowledge, has there ever been any concern regarding this applicants ethical conduct? ( Yes ( NoIf yes, please provide details. Do you have any reason to believe that this applicant should not be granted registration as a social worker? ( Yes ( No If yes, please provide details. Do you believe that on an overall basis, including ethics, conduct, character, and competence, this applicant is or would be a credit to the profession? ( Yes ( NoIf no, please provide details.Please provide any additional comments  _______________________________________ _______________________________________ Signature Date RSW Number _________________ Contact Telephone Number: (_____)______________________ Agency/Organization: _________________________________________________________________________ Agency/Organization Address: __________________________________________________________ ____________________________________________________________________________________ The Registrar may contact you for more information or for clarification. Please submit your reference to: The Registrar Alberta College of Social Workers 550-10707 100 Avenue NW Edmonton, Alberta T5J 3M1 Please note: Under freedom of information requirements, your comments may be shared with the applicant. If you have any questions about the registration process, please contact the ACSW office at (780)421-1167 or toll-free in Alberta at 1-800-661-3089. Thank you for your cooperation. APPLICATION FOR REGISTRATION AS A REGISTERED SOCIAL WORKER SUPERVISOR REFERENCE FORM Applicant, please complete this section: Supervisors NameAgency/organizationSupervisors Work Address Applicants Name Supervisor, please complete the remainder of the form: The above named applicant has made an application to become a Registered Social Worker under the Health Professions Act (1999). The Act requires that the candidate for registration (must provide evidence of having good character and reputation(. Registration in social work is a commitment to skilled and ethical practice. Registered Social Workers are accountable for their practice to the public and to the profession. You have been named as a supervisor by the applicant. If you were not the applicants direct supervisor, please provide a separate page detailing your relationship with the applicant, how you observed the applicants practice, and how you developed the knowledge to respond to the questions below. How long have you known the applicant?When did you begin supervising this applicant?Are you still this applicant(s supervisor? ( Yes ( NoIf no, when did you stop supervising this applicant? Approximately how many hours of direct supervision did you spend with this applicant?Total practice hours for which you supervised this applicant: hours/week x # of weeksPlease describe the situations in which you have observed the applicant engaged in social work practice Is the applicant currently engaged within the scope of social work practice? ( Yes ( NoWhat is the applicants primary field of practice? In your opinion, does the applicant possess the personal and professional integrity to practice social work in accordance with the current Social Work Code of Ethics? ( Yes ( No Please provide examplesHow does the applicant demonstrate respect for the client-social worker relationship?Please provide examples Please add additional pages if necessary. How does the applicant demonstrate knowledge regarding current ethical issues in social work practice? To your knowledge, has there ever been any concern regarding this applicants ethical conduct? ( Yes ( NoIf yes, please provide details. Do you have any reason to believe that this applicant should not be granted registration as a social worker? ( Yes ( NoIf yes, please provide details: Do you believe that on an overall basis, including ethics, conduct, character, and competence, this applicant is or would be a credit to the profession? ( Yes ( NoIf no, please provide details: Please provide any additional comments.  ______________________________________________ _______________________________________ Signature Date RSW Number _________________ Contact Telephone Number: (_____)______________________ Agency/Organization: _________________________________________________________________________ Agency/Organization Address: __________________________________________________________________ ___________________________________________________________________________________________ The Registrar may contact you for more information or for clarification. Please submit your reference to: The Registrar Alberta College of Social Workers 550-10707 100 Avenue NW Edmonton, Alberta T5J 3M1 Please note: Under freedom of information requirements, your comments may be shared with the applicant. If you have any questions about the registration process, please contact the ACSW office at (780)421-1167 or toll-free in Alberta at 1-800-661-3089. Thank you for your cooperation. Health Professions Act Frequently Asked Questions On April 1, 2003, the profession of social work came under the Health Professions Act (HPA) and the Social Work Profession Act was repealed. The purpose of the HPA is to serve and protect the public interest. The HPA covers 30 professions, regulated by 28 professional colleges, of which the Alberta College of Social Workers (ACSW) is one. The following information is intended to be a quick resource with answers to those questions most frequently asked by social workers, employers of social workers, and other interested people. If you have a question that is not answered in this list, you can access the legislation at HYPERLINK "%20http://www.qp.alberta.ca/"  http://www.qp.alberta.ca/. The Social Workers Profession Regulation can also be obtained at that site. If you have checked these documents and still have not found the answer to your question, please put your question in writing to acswreg@acsw.ab.ca. Every effort will be made to ensure that you have access to reliable information as quickly as possible. What is Social Work? Under the Health Professions Act (HPA), Schedule 27, the practice of social work is defined as follows: In their practice, social workers do one or more of the following: (a) enhance or restore the social functioning of individuals, families, groups, organizations and communities by improving developmental, problem-solving and coping capacities of people and systems, (b) promote effective and humane systems that provide resources, opportunities and services to people and link people to those systems, (c) contribute to the development and improvement of social policy, and (d) provide restricted activities authorized by the regulations. If your practice involves any of the above, you are active in social work. Who has to be a Registered Social Worker? Registration is required if you qualify for registration as a social worker, you are working in a position that falls within the scope of social work as defined above, and (a) you work with the public; or (b) you supervise people who work with the public; or (c) you teach members of the profession. How do I know if I qualify for registration? You qualify to apply for registration if: (a) you have a degree in social work from any university in North America that is accredited by the Canadian Association of Social Work Education (CASWE) or the Council on Social Work Education (CSWE); or (b) you have graduated from an approved social work diploma program in Alberta; or (c) you have, within the last three years, been a registered, certified or licensed social worker in another province or with a member of the Association of Social Work Boards. What if I have a social work education from another country? If you are a graduate of an advanced education program in social work that does not fit these criteria, you may apply to have your credentials assessed for equivalence. This is not done directly by the Alberta College of Social Workers. You will need to complete an application for assessment with the International Qualifications Assessment Service ( HYPERLINK "http://employment.alberta.ca/immigration/4512.html" http://employment.alberta.ca/immigration/4512.html), or the Canadian Association of Social Workers (HYPERLINK "http://www.casw-acts.ca/"www.casw-acts.ca/). The original assessment must be submitted to the ACSW office. What if I don't call myself a social worker? It does not matter what title you use: if your position fits within the scope of practice defined above you must be registered to practice. You are encouraged to use the title "Social Worker" in all professional practice, but this is not a requirement. The title "Social Worker" may only be used by qualified social workers. What if my employer says I don't have to be registered to do my job? An employer is free to set any job requirements for hiring. The employer cannot, however, decide that a qualified social worker does not have to be registered. This may mean that you are doing exactly the same job as another person who is not required to be a registered social worker because that other person does not qualify for registration. That person is not a social worker. What do I need to do to become a Registered Social Worker? Complete the application package and provide all the documents and fees required. As soon as the paperwork is complete, if there are no problems with your application, you will receive your social work practice permit. Please note: It is your responsibility to ensure that all documentation is received at the ACSW office. We will notify you once only that we have received your application and what documents we are waiting for. If you have not received your practice permit within a reasonable time after receiving this letter (normally three to four weeks) please check to see if something is still missing from your application package. What is Provisional Registration? All registrants are required to practice under the supervision of a qualified social worker for at least 1500 hours to becoming fully registered. During the qualifying period you must apply for provisional registration. Once you have completed the 1500 practice hours (which may include practicum hours), a qualified social worker who supervised at least 350 out of your last 500 hours of practice is required to complete a supervision reference form on your behalf in order for your registration to be complete. To certify my supervised practice, who is a qualified social worker? A qualified social worker is registered, licensed, or certified in the jurisdiction in which she/he practices. The social worker will be considered qualified if she/he is registered was registered during the period of supervision (eg RSW then and now retired). Will I automatically become a Registered Social Worker once all the documents are received? Not necessarily. If there are any problems related to your references or other documents we will contact you. Applicants who have not been in a social work education program or registered/licensed within the past three years must also pass an examination as part of the registration process. What examination? ACSW is a member of the Association of Social Work Boards. We use their examinations, which are used and may be recognized by many jurisdictions throughout North America. Details about the exams can be found at www.aswb.org. Are there any other qualifications I must meet to get registered? There is provision in the legislation for assessing each applicant's character and reputation. This is done through a combination of things, including a Criminal Record Check, references, and a personal declaration. If the information on any of these documents suggests that there may be questions with regard to your suitability for the profession, you will be asked to provide additional details. The Registrar or Registration Committee will determine whether to proceed with the registration process. I had to get a Criminal Record Check for my employer last month. Can I send you a copy of that rather than get a new one? The ACSW will accept a copy, certified by your human resources manager to be true, if it was produced within the last 90 days. If it is older than that you must get a new one. I have just graduated and can't get official transcripts yet. What else may I use to provide evidence of qualification for registration? For the purpose of issuing a Provisional Practice Permit, the ACSW requires something that shows you have completed a degree or diploma from an approved social work program. We will accept a photocopy of your degree/diploma, an unofficial copy of your transcripts, or a letter issued by the university or college that states that you have completed your social work education program. However, official transcripts must be submitted before you will qualify for full registration. Can I call myself a Registered Social Worker if my registration is provisional? Yes. You will receive a provisional practice permit and are entitled to use the titles and abbreviations associated with registration: Registered Social Worker, Social Worker, RSW, SW, Soc. Wkr. Only social workers who have been approved for membership on the Clinical Specialty Registry may use the title "Clinical Social Worker". Do I have to tell my clients that I am registered? Yes. If any client asks whether you are a registered social worker you must provide them with the information. You are encouraged to use your RSW and indicate your educational qualifications on all professional documents as well. Why do I need to provide evidence of having liability insurance? The basic purpose of professional regulation is protection of the public we serve. Part of ensuring the public is protected is through liability insurance. If your employer provides coverage that covers staff, documentation of that coverage will be accepted. However, all social workers are strongly encouraged to carry their own insurance. Details regarding the group plan through the Canadian Association of Social Workers are available from the ACSW office. If I am working in an unpaid (volunteer) position, do I have to have liability insurance? Yes. All practicing RSW(s must show evidence of having liability coverage. Most voluntary agencies have insurance coverage for volunteers. If your position is not covered, you must carry your own liability insurance. What happens if I take a leave from social work practice? There are two options available to people taking a leave from practice. You may retain your registration status as "inactive" for a reduced fee, which keeps your name on the mail list and your file current. You may also cancel your registration while you are inactive and reinstate your registration when you rsum practice in the future. If I cancel my registration while I'm on leave, do I have to go through the whole application process again? Not necessarily. Your file will be retained for ten years following cancellation so things like transcripts will not have to be replaced. You will need to provide details of your continuing competence activities during your leave (if any). Depending on the purpose of your leave, you may be asked to provide additional information. If the leave was three years or longer, you may be required to work for a period of time under the supervision of a social worker or to take a refresher course prior to returning to practice. If your leave was longer than five years and you were not practicing as a regulated social worker elsewhere during that period, you will have to pass an examination in order to reinstate your registration. What will happen if I don't get registered? If you qualify for registration, the bottom line is that you are not eligible to practice within the scope of social work without being registered and a fine may be imposed if the regulations are not adhered to. As well, the Health Professions Act states that an employer may not knowingly employ a person within the scope of practice who is required to be registered if that person does not apply for registration. An employer may also be subject to a fine for employing an unregulated professional. For details, please see the Act. What if I get registered now but don't renew my registration in the future? The Health Professions Act requires that the ACSW notify your employer if your registration gets cancelled. When must my application for registration be submitted? Registration is a requirement for all practising social workers. You should submit your complete application as soon as possible following the completion of your social work education. You may want to start compiling the supporting documentation during your final semester of coursework. Do employers normally pay social work registration fees? No. Most Registered Social Workers pay their own fees. The full cost of registration can be claimed on your Income Tax as Professional Dues if you pay your own fees. Are there other requirements for maintaining my status as a Registered Social Worker? Yes. Go to the ACSW web site,  HYPERLINK "www.acsw.ab.ca" www.acsw.ab.ca, for additional information about ongoing registration requirements. When will I have to pay my renewal fees? In order to maintain your registration, annual fees are required. The date of payment is based on your registration. If your registration is issued between January 1 and March 31, your renewal dues will be payable by November 30. Your renewal date will be November 30 of each calendar year. If your registration is issued between April 1 and June 30, your renewal dues will be payable by February 28 of the following year. Your renewal date will be February 28 of each year. If your registration is issued between July 1 and September 30, your renewal dues will be payable by May 31 of the following year. Your renewal date will be May 31 of each year. If your registration is issued between October 1 and December 31, your renewal dues will be payable by August 31 of the following year. Your renewal date will be August 31 of each year. Please note that this is for the future renewal of registration. Your initial registration fees are required at time of application. *** Much more information is available on the ACSW web site, www.acsw.ab.ca. Some information on the site is only available to ACSW members, and you must be logged on for access. You will receive a user name and password when your application is approved (including student applications). You cannot change your user name, but you may log on and change your password under Preferences if you wish to do so. 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