| 1. I am interested in being a part of this Coalition because I am a: |
|---|
 | MSW Student |
| New MSW graduate |
| LMSW |
| LMSW Accruing supervised hours in clinical social work |
| LCSW Applicant |
| LCSW Applicant disapproved by NYS Board of Social Work |
| LCSW in support of NYS Coalition of LMSWs |
| Other (please specify) |