Nursing

Application Forms: RN & LPN

Instructions for completing and submitting the forms required for licensure appear below. You may also need to submit additional information (for example, examination scores). Please refer to the license requirements link on the left for complete information regarding all requirements you must meet.

Note: All forms are in Adobe Portable Document Format (PDF). To view or print these documents, you will need to have the free Adobe Reader installed on your computer. Download times and print quality will depend on your connection speed and printer.

Adobe Reader

Please type or print all information and sign all forms in black or blue ink. Original signatures are required on all forms.

Form 1 - Application for Licensure (nurse1.pdf; 66K; 4 pages)

All applicants for licensure must complete this form and submit it with the $135 licensure and first registration fee directly to the Office of the Professions at the address at the end of Form 1. Make checks payable to the New York State Education Department. NOTE: Your cancelled check is your receipt.

You must answer all questions and provide all information requested unless otherwise indicated. Failure to complete all required parts of the application will delay its review. Your signature on Form 1 must be notarized by a Notary Public. Upon receipt of your application, we will send you an acknowledgement letter.

If you are applying for licensure as a licensed practical nurse, you must submit a copy of your high school or secondary school diploma or transcript in the original language with your Form 1.

If you were educated outside the U.S., submit a copy of your nursing diploma in the original language.

Address/Name Change Form - Optional (anchange.pdf; 16K; 2 pages)

You are required to notify us within 30 days of any name or address changes. Please read the instructions and complete the appropriate sections of this form.

Form 2 - Certification of Professional Education (If applicable) (nurse2.pdf; 28K; 2 pages)

This form must be submitted directly by the nursing school. The Office of the Professions will not accept this form if submitted by the applicant.

• If you graduated after April 1, 1998 from a New York State licensure qualifying program registered by the State Education Department, your school will notify us of your educational qualifications. You do not have to submit Form 2.
  
  
• If you completed a New York State licensure qualifying program prior to April 1, 1998, or obtained your education in the United States but not in New York State, complete Section I of Form 2 and forward the entire form to your school of nursing to complete and submit directly to the State Education Department.
  
  
• If your education was obtained in another country, do not use Form 2. You must have your educational credentials verified by CGFNS, an independent credentials verification organization, before the New York State Education Department can determine if your credentials meet New York State's requirements for licensure. See "Verifying Education Credentials From Non-U.S. Programs". Contact CGFNS for the forms and procedures for the independent verification of your education credentials (see contact information).

Form 2AF - Certification Of Equivalent U.S. Armed Forces Education For LPN Licensure (nurse2af.pdf, 29K; 2 pages)

Complete this form ONLY if you are applying for an LPN license based on completion of equivalent education in a program conducted by the U.S. armed forces.

The Office of the Professions will not accept this form if submitted by the applicant.

Section I: Complete this section of the form and forward the entire form to the U.S. armed forces program to complete and submit directly to the Office of the Professions at the mailing address on the form.

Section II: The U.S. armed forces program must complete this section, sign, date and return both pages of the form directly to the Office of the Professions with an official transcript in a sealed armed forces envelope.

Form 3 - Verification of Other Professional Licensure/Certification (nurse3.pdf, 34K; 2 pages)

Complete this form if you hold, or have ever held, a license or certificate to practice any profession* in any jurisdiction. For additional information on verifying nurse licensure, see Verification of Nurse Licensure in Another State.

This form must be submitted directly by the licensing/certifying authority. The Office of the Professions will not accept this form if submitted by the applicant.

Section I: Complete this section before sending the entire form to the licensing/certifying authority of each jurisdiction in which you are or have been licensed/certified. Be sure to sign and date item 9.

Section II: The licensing/certifying authority must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

Form 5 - Application for Limited Permit (nurse5.pdf, 37K; 3 pages)

Section I: If you are applying for a limited permit, complete this section before asking your prospective employer to complete Section II.

Section II: Ask your prospective employer to complete this section.

You may apply for a limited permit either at the same time as or after submitting an Application for Licensure (Form 1) and the licensure fee of $135. If you have not yet filed a Form 1 and the licensure fee, you must submit them with the Form 5 and the limited permit fee of $35.

Return all 3 pages of the completed form with the $35 fee to the Office of the Professions at the address at the end of the form. You must meet all requirements for licensure, except the examination requirement, to be eligible for a limited permit. RN applicants - If you did not complete the required coursework or training in the identification and reporting of child abuse as part of a New York State educational program, you must submit a certificate of completion from an approved provider or a Certification of Exemption (Form 1CE).

Child Abuse Certification of Exemption Form - (form1ce.pdf; 40k; 1 page)

This form is not for all applicants. Use this form only if you are applying for an exemption to the requirement to complete training or coursework in the identification of child abuse and maltreatment because the nature of your practice excludes contact with persons under the age of 18 and persons 18 or older with a handicapping condition who reside in a residential care school or facility.

You may register online directly with the examination provider, VUE, the electronic testing service of NCS Pearson, to take NCLEX.