1 Welcome2 Eligibility3 Contact/Payment Welcome!This online application for the Board Certified Diplomate in Clinical Social Work (BCD) requires no test. It has two parts: A brief eligibility section collecting eligibility information and $350 payment. A more detailed section in which you describe your education, training, and practice, and you name two colleagues to evaluate your practice. In order for this application to be completed, you must fill out all items and finish by clicking the SUBMIT button.Do you work for the Department of Veterans Affairs?*YesNo EligibilityDo you hold a master’s degree in social work with coursework and fieldwork focused on direct practice?*YesNoDo you hold a current state license in clinical social work (if you are a V.A. employee, the V.A. identifies the requisite state license as "advanced practice level".)?*YesNoHave you practiced clinical social work for at least 5 years (7,500 hours) post master's, including 2 years (3,000 hours) under supervision, of which at least 1 year (1,500 hours) was supervised by an Advanced Clinical Social Worker?*Advanced Clinical Social Worker Characteristics - Master’s degree in social work; at least five years of post-graduate clinical social work practice, including two years under clinical supervision; current in practice (3,000 hours in the past 10 years, including at least 300 hours within the past 12 months); licensed in good standing at the highest clinical level available in each state (or jurisdiction) where you practice.YesNoYour response indicates that you are not eligible for this credential. If your response was in error, please correct it so you can continue. Otherwise, you are advised not to try to complete this application, for your money will not be refunded if you are found ineligible. Questions? Please contact email@example.com. All applicants are subject to a random audit of their continuing education and current practice.All applicants are subject to a random audit of their continuing education and current practice. Questions regarding your eligibility? Please contact firstname.lastname@example.org. Name* First Middle Initial Last Preferred Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Daytime Phone*ExtensionEmail*(not va.gov) User Name (Do not use email address)*Password*A strong password is required. Use upper and lowercase letters, numbers and symbols like !”?$%^&). Enter Password Confirm Password Strength indicator BCD Application Fee* Price: $350.00 Testing Discount Price: -$350.00 Total Due $0.00 Accepted Credit Cards* American ExpressMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Security Code Cardholder Name Wait a few seconds for processing after clicking ‘Submit’BCD NumberEmailThis field is for validation purposes and should be left unchanged.