Florida Department of State and Division of Library and Information Services

Reference: Ref-12736

Reference Name: DH5046-MQA_ Graduate Level Practicum Internship or Field Experience Verification Form CSW
Agency: 64 Department of Health
64b4 Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling

Modified Document(s):
1/30/2024 Updating the email address top left of form and spelling out Florida Statutes under 3.
Original Document(s):
2/9/2021
Description:

Disclaimer: External links within the reference material are subject to change outside of the rulemaking process.

Rules/Notices using this Reference Material
Notice /
Adopted		 Section Description ID Publish
Date
View Text Final
64B4-3.0085 		Intern Registration 27126746 Effective:
05/30/2023
View Text Final
64B4-3.0085 		Intern Registration 24916892 Effective:
09/08/2021
View Text Final
64B4-3.0085 		Intern Registration 24239250 Effective:
03/09/2021



Under Florida law, E-mail addresses are public records. If you do not want your E-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.