Forms on OP's Website
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.
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.Profession name begins with: A -
C - D - E - I -
L - M - N - O -
P - R - S - V
Non-Profession Specific Application Forms
Acupuncture
- Acupuncture Form 1 - Application for Licensure & First Registration
(
44 KB) - Acupuncture Form 2A - Certification of Pre-professional
College/University Education
( 22
KB)
- Acupuncture Form 2B - Certification of Professional Acupuncture
Education
( 22
KB)
- Acupuncture Form 5 - Application for Limited Permit
( 23
KB)
Architecture
- Architecture Form 1 - Application for Licensure
( 26
KB)
- Architecture Form 2 - Certification of Professional Education
( 17
KB)
- Architecture Form 3 - Verification of Out-of-state Licensure,
Registration and/or Examination (
21
KB)
- Architecture Form 4 - Applicant Experience Verification ( 20
KB)
Athletic Training
- Athletic Training Form 1 - Application for Certification
( 46
KB)
- Athletic Training Form 2 - Certification of Professional
Education
( 30
KB)
- Athletic Training Form 2B - Certification of Equivalent
Practicum Experience
( 26
KB)
- Athletic Training Form 3 - Verification of Other Professional
Licensure/Certification
( 26
KB)
Audiology
- Speech-Language Pathology and Audiology Form 1 - Application
for Licensure
( 44 KB)
- Speech-Language Pathology and Audiology Form 2 - Certification
of Professional Education
( 22
KB)
- Speech-Language Pathology and Audiology Form 3 - Verification of Other Professional Licensure/Certification ( 18 KB)
- Speech-Language Pathology and Audiology Form 4A - Identification
of Supervisor and Setting
( 18
KB)
- Speech-Language Pathology and Audiology Form 4B - Record
of Supervised Experience
( 18
KB)
Certified Shorthand Reporting
- Certified Shorthand Reporting Form 1 - Application for
Licensure & First Registration ( 41
KB)
- Certified Shorthand Reporting Form 2 - Certification
of Education
( 21
KB)
- Certified Shorthand Reporting Form 4 - Certification
of Experience
( 21
KB)
Chiropractic
- Chiropractic Form 1 -
Application for Licensure & First Registration ( 38
KB)
- Chiropractic Form 2 - Certification of Education
( 16
KB)
- Chiropractic Form 3 - Verification of Chiropractic Licensure
in Another Jurisdiction
( 18
KB)
- Chiropractic Form 4 - Verification of Experience
( 16
KB)
Clinical Laboratory Technology
- Clinical
Laboratory Technologist & Clinical Laboratory
Technician
- Clinical Laboratory Technologist/Technician Form
1 - Application for Licensure
( 26
KB)
- Clinical Laboratory Technologist/Technician Form
2 - Certification of Professional Education
( 18
KB)
- Clinical Laboratory Technologist/Technician Form
3 - Verification of Other Professional Licensure/Certification
( 19
KB)
- Clinical Laboratory Technologist/Technician Form
4A - Certification of Experience (For Grandparenting
Applicants Only)
( 19
KB)
- Clinical Laboratory Technologist/Technician Form
4B - Certification of Faculty Member/Managing Administrator
Status (For Clinical Laboratory Technologist Applicants
Using Grandparenting Method Four Only)
( 14
KB)
- Clinical Laboratory Technologist/Technician Form 4C - Certification of Experience and Competence
- Clinical Laboratory Technologist/Technician Form
5 - Application for Limited Permit
( 19
KB)
- Clinical Laboratory Technologist/Technician Form
1 - Application for Licensure
(
- Cytotechnologist
- Cytotechnologist Form 1 - Application for Licensure
( 27
KB)
- Cytotechnologist Form 2 - Certification of Professional
Education
( 18
KB)
- Cytotechnologist Form 3 - Verification of Other Professional
Licensure/Certification
( 19
KB)
- Cytotechnologist Form 4A - Certification of Experience
(For Grandparenting Applicants Only)
( 18
KB)
- Cytotechnologist Form 4C - Certification of Experience and Competence ( 18 KB)
- Cytotechnologist Form 5 - Application for Limited
Permit
( 19
KB)
- Cytotechnologist Form 1 - Application for Licensure
(
Dental Professions
- Certified
Dental Assistant
- Certified Dental Assisting Form 1 - Application for
Licensure
( 23
KB)
- Certified Dental Assisting Form 2 - Certification
of Professional Education
( 19
KB)
- Certified Dental Assisting Form 5 - Application for
Limited Permit
( 18
KB)
- Certified Dental Assisting Form 1 - Application for
Licensure
(
- Dental
Hygienist
- Dental Hygiene Form 1 - Application for Licensure & First Registration ( 41
KB)
- Dental Hygiene Form 2 - Certification of Professional
Education
( 21
KB)
- Dental Hygiene Form 3 - Certification of Licensure
( 22
KB)
- Dental Hygiene Form 4A - Personal Affidavit of Professional
Practice for Endorsement Applicants
( 13
KB)
- Dental Hygiene Form 4B - Verification of Professional
Practice
( 20
KB)
- Dental Hygiene Form 5 - Application for Limited Permit ( 17 KB)
- Dental Hygiene Restricted Local Infiltration Anesthesia/Nitrous
Oxide Analgesia Certification - Application for Certification & First Registration
( 27
KB)
- Dental Hygiene Restricted Local Infiltration Anesthesia/Nitrous
Oxide Analgesia Certification - Verification of Education
( 28
KB)
- Dental Hygiene Form 1 - Application for Licensure & First Registration (
- Dentist
- Dentist Form 1 - Application for Licensure
( 25
KB)
- Dentist Form 2 - Certification of Professional Education
( 18
KB)
- Dentist Form 3 - Verification of Other Professional License/Certification
( 18
KB)
- Dentist Form 4 - Personal Affidavit of Professional
Practice for Endorsement Applicants
( 11
KB)
- Dentist Form 4A - Supporting Affidavit of Professional
Practice for Endorsement Applicants
( 12
KB)
- Dentist Form 4B - Certification of Clinical Residency
Program Completion
( 22
KB)
- Dentist Form 5 - Application for a Limited Permit ( 30
KB)
- Dentist Form 1AC-R - Application for Certification to Use Acupuncture
( 18
KB)
- Dentist Form 2AC - Certification of Acupuncture Education
( 15
KB)
- Dentist Form 1 - Application for Licensure
(
- Dental Anesthesia Certification (for licensed dentists
only)
- Dental Anesthesia Form 1 - Application for Certification
( 42
KB)
- Dental Anesthesia Forms 2 A, B and C - Verification of Program Completion
- Dental Anesthesia Form 1 - Application for Certification
(
Dietetics and Nutrition
- Dietetics and Nutrition Form 1 - Application for Certification & First Registration
( 39
KB)
- Dietetics and Nutrition Form 2 - Cerification of Professional
Education
( 22
KB)
- Dietetics and Nutrition Form 3E - Certification of Dietetics-Nutrition
Examination Results
( 20
KB)
- Dietetics and Nutrition Form 4 - Applicant Professional
Experience Record
( 20
KB)
- Dietetics and Nutrition Form 4B - Report of Experience Record
( 24
KB)
- Dietetics and Nutrition Form 4C - Report of Planned Work
Experience
( 27
KB)
- Dietetics and Nutrition Form 4E - Endorsement by an Acceptable
Dietitian-Nutritionist
( 17
KB)
Engineering
- Engineering Form 1 - Application for Licensure & First Registration ( 42
KB)
- Engineering Form 2 - Certification of Professional Education
( 24
KB)
- Engineering Form 3 - Verification of Out-of-State Licensure,
Examination and/or Education
( 27
KB)
- Engineering Form 4 - Report of Professional Experience
( 34
KB)
- Engineering Form 4A - Verification of Professional Experience
( 28
KB)
- Engineering Form 5 - Notification of Intent to Practice
Professional Engineering Under Section 7208(b) of the Education
Law
( 15
KB)
Interior Design
- Interior Design Form 1 - Application for Licensure & First Registration ( 41
KB)
- Interior Design Form 2 - Certification of Professional
Education
( 21
KB)
- Interior Design Form 4 - Report of Professional Experience
( 21
KB)
- Interior Design Form 4A - Verification of Experience
( 24
KB)
Landscape Architecture
- Landscape Architecture Form 1 - Application for Licensure
( 57
KB)
- Landscape Architecture Form 2 - Certification of Education
( 25
KB)
- Landscape Architecture Form 3 - Verification of Out-of-state
Licensure, Registration and/or Examination
( 27
KB)
- Landscape Architecture Form 4 - Report of Professional Experience ( 20
KB)
- Landscape Architecture Form 4A - Verification of Professional Experience ( 49
KB)
- Landscape Architecture Form 5 - Application for Limited Permit for Non-Resident Landscape Architect ( 54
KB)
Land Surveying
- Land Surveying Form 1 - Application for Licensure
( 24
KB)
- Land Surveying Form 2 - Certification of Professional Education
( 18
KB)
- Land Surveying Form 3 - Verification of Out of State
Licensure, Registration and/or Examination
( 20
KB)
- Land Surveying Form 4 - Report of Professional Experience
( 14
KB)
- Land Surveying Form 4A - Verification of Professional Experience
( 8
KB)
- Land Surveying Form 5 - Notification of Intent to Practice
Land Surveying Under Section 7208(b) of Education Law
( 12
KB)
Massage Therapy
- Massage Therapy Form 1 - Application for Licensure & Frist Registration
( 41
KB)
- Massage Therapy Form 2 - Certification of Professional
Education
( 29
KB)
- Massage Therapy Form 3 - Verification of Out-of-State Licensure or Registration
( 22
KB)
- Massage Therapy Form 4 - Report of Professional Experience
( 20
KB)
- Massage Therapy Form 4B - Verification of Experience
( 31
KB)
- Massage Therapy Form 5 - Application for Limited Permit
( 27
KB)
Medical Physics
- Medical Physics Form 1 - Application for Licensure & First Registration
( 37
KB)
- Medical Physics Form 2 - Certification of Professional
Education
( 23
KB)
- Medical Physics Form 4 - Personal Affidavit of Professional
Practice
( 20
KB)
- Medical Physics Form 4A - Verification of Professional
Experience
( 20
KB)
- Medical Physics Form 5 - Application for Limited Permit
( 45
KB)
Medicine
- Physician
- Medicine Form 1 - Application for Licensure & First Registration
( 55
KB)
- Medicine Form 2 - Certification of Professional and
Pre-professional Education
( 21
KB)
- Medicine Form 2CC - Certification of Approved Clinical
Clerkship
( 20
KB)
- Medicine Form 2PGT - Certification of Approved Postgraduate
Training
( 19
KB)
- Medicine Form 3A - Verification of Medical Licensure
in Another Country
( 15
KB)
- Medicine Form 3B - Verification of pre-1972 Licensure
in Another U.S. State or Territory
( 18
KB)
- Medicine Form 4 - Verification of Professional Practice
of Medicine in Another Jurisdiction
( 17
KB)
- Medicine Form 5A - Application for Limited Permit
in Medicine for Applicants Seeking Licensure in New
York State
( 28
KB)
- Medicine Form 5B - Application for Limited Permit
for Applicants Who have not Licensure in New York State
( 44 KB)
- Medicine - Certification of Fifth (5th) Pathway Program
( 15
KB)
- Medicine -
Request for Status Report of ECFMG Certification
( 25
KB)
- Medicine Form 1AC-R - Application for Certification to Use Acupuncture
( 18 KB)
- Medicine Form 2AC - Certification of Acupuncture
Education
( 15 KB)
- Medicine Education Record
( 23 KB)
- Post Medical School Activity Record
( 13 KB)
- Medicine Form 1 - Application for Licensure & First Registration
(
- Physician
Assistant
- Physician Assistant Form 1 - Application for Licensure
( 42
KB)
- Physician Assistant Form 2 - Certification of Professional
Education
( 22
KB)
- Physician Assistant Form 3 - Verification of Licensure/Certification
in Another Jurisdiction
( 23
KB)
- Physician Assistant Form 5 - Application for Limited
Permit
( 26
KB)
- Physician Assistant Form 1 - Application for Licensure
(
- Specialist Assistant
Mental Health Practitioners
- Creative
Arts Therapy
- Creative Arts Therapy Form 1 - Application for Licensure
( 52
KB)
- Creative Arts Therapy Form 2 - Certification of Professional
Education
( 24
KB)
- Creative Arts Therapy Form 3 - Verification of Other
Professional Licensure/Certification
( 26
KB)
- Creative Arts Therapy Appendix A - Requirements for
Supervised Experience
( 21
KB)
- Creative Arts Therapy Form 4 - Applicant Experience Record
( 25
KB)
- Creative Arts Therapy Form 4B - Certification of
Supervised Experience
( 29
KB)
- Creative Arts Therapy Form 4E - Endorsement Applicant Experience Record - ( 17 KB)
- Creative Arts Therapy Form 4F - Certification of Licensed Experience - ( 18 KB)
- Creative Arts Therapy Form 5 - Application for Limited
Permit
( 31
KB)
- Creative Arts Therapy Form 1 - Application for Licensure
(
- Marriage
and Family Therapy
- Marriage and Family Therapy Form 1 - Application
for Licensure
( 49
KB)
- Marriage and Family Therapy Form 2 - Certification
of Professional Education
( 24
KB)
- Marriage and Family Therapy Form 3 - Verification
of Other Professional Licensure/Certification
( 26
KB)
- Marriage and Family Therapy Appendix A - Requirements
for Supervised Experience
( 22
KB)
- Marriage and Family Therapy Form 4 - Applicant Experience Record
( 25
KB)
- Marriage and Family Therapy Form 4B - Certification
of Supervised Experience
( 30
KB)
- Marriage and Family Therapy Form 4E - Endorsement Applicant Experience Record - ( 17 KB)
- Marriage and Family Therapy Form 4F - Certification of Licensed Experience - ( 19 KB)
- Marriage and Family Therapy Form 5 - Application
for Limited Permit
( 32
KB)
- Marriage and Family Therapy Form 1 - Application
for Licensure
(
- Mental
Health Counseling
- Mental Health Counseling Form 1 - Application for
Licensure
( 52
KB)
- Mental Health Counseling Form 2 - Certification of
Professional Education
( 24
KB)
- Mental Health Counseling Form 3 - Verification of
Other Professional Licensure/Certification
( 26
KB)
- Mental Health Counseling Appendix A - Requirements
for Supervised Experience
( 21
KB)
- Mental Health Counseling Form 4 - Applicant Experience Record
( 25
KB)
- Mental Health Counseling Form 4B - Certification
of Supervised Experience
( 29
KB)
- Mental Health Counseling Form 4E - Endorsement Applicant Experience Record - ( 17 KB)
- Mental Health Counseling Form 4F - Certification of Licensed Experience - ( 19 KB)
- Mental Health Counseling Form 5 - Application for
Limited Permit
( 31
KB)
- Mental Health Counseling Form 1 - Application for
Licensure
(
- Psychoanalysis
- Psychoanalysis Form 1 - Application for Licensure
( 52
KB)
- Psychoanalysis Form 2 - Certification of Psychoanalytic Study
( 24
KB)
- Psychoanalysis Form 2A - Certification of Graduate
Study
( 24
KB)
- Psychoanalysis Form 3 - Verification of Other Professional
Licensure/Certification
( 26
KB)
- Psychoanalysis Appendix A - Requirements for Supervised
Experience
( 25
KB)
- Psychoanalysis Form 4 - Applicant Experience Record
( 21
KB)
- Psychoanalysis Form 4B - Certification of Supervised
Experience
( 29
KB)
- Psychoanalysis Form 4E - Endorsement Applicant Experience Record - ( 17 KB)
- Psychoanalysis Form 4F - Certification of Licensed Experience - ( 19 KB)
- Psychoanalysis Form 5 - Application for Limited Permit
( 32
KB)
- Psychoanalysis Form 1 - Application for Licensure
(
Midwifery
- Midwifery Form 1 - Application for Licensure
( 40
KB)
- Midwifery Form 2 - Certification of Professional Education
( 23
KB)
- Midwifery Form 2A - Certification Of Pharmacology Course
or the Equivalent of Not Less Than Three Semester Hours
( 22
KB)
- Midwifery Form 2B - Certification of Instruction in New
York State and Federal Laws Relating to Prescriptions and
Record Keeping
( 22
KB)
- Midwifery Form 5 - Application for Limited Permit
( 25
KB)
Nursing
- Registered
Professional Nurse and Licensed Practical Nurse
- Nursing Form 1 - Application for Licensure
( 51
KB)
- Nursing Form 2 - Certification of Professional Education
( 28
KB)
- Nursing Form 2AF - Certification Of Equivalent U.S.
Armed Forces Education For LPN Licensure
( 29
KB)
- Nursing Form 3 - Verification of Other Professional License/Certification
( 34
KB)
- Nursing Form 5 - Application for Limited Permit
( 37
KB)
- Nursing Form 1 - Application for Licensure
(
- Nurse
Practitioner
- Nurse Practitioner Form 1 - Application for a Certificate
( 24
KB)
- Nurse Practitioner Form 2 - Certification of Professional
Education
( 18
KB)
- Nurse Practitioner Form 2B - Verification of Instruction
in New York State and Federal Laws Related to Prescriptions
and Record Keeping
( 17
KB)
- Nurse Practitioner Form 2C - Verification of Pharmacotherapeutics
Course
( 18
KB)
- Nurse Practitioner Form 3 - Verification of National
Nurse Practitioner Examination
( 18
KB)
- Nurse Practitioner Form 4 - Verification of Experience
( 20
KB)
- Nurse Practitioner Form 4NP - Verification of Collaborative Agreement and Practice
Protocol
( 14
KB)
- Nurse Practitioner Form 1 - Application for a Certificate
(
Occupational Therapy
- Occupational Therapy Form 1 - Application for Licensure & First Registration
( 45
KB)
- Occupational Therapy Form 2 - Certification of Professional
Education
( 27
KB)
- Occupational Therapy Form 3 - Verification of Other Professional Licensure/Certification
- ( 18
KB)
- Occupational Therapy Form 5 - Application for a Limited
Permit
( 29
KB)
Ophthalmic Dispensing
- Ophthalmic Dispensing Form 1 - Application for Licensure & First Registration
( 42
KB)
- Ophthalmic Dispensing Form 2 - Certification of Professional
Education in Ophthalmic Dispensing
( 25
KB)
- Ophthalmic Dispensing Form 3 - Certification of Ophthalmic
Dispensing Licensure in Another Jurisdication
( 24
KB)
- Ophthalmic Dispensing Form 4 - Certification of Trainee
Experience in Ophthalmic Dispensing And/Or Contact Lens
Dispensing
( 13
KB)
- Ophthalmic Dispensing Form 5 - Application for Limited
Permit
( 31
KB)
- Ophthalmic Dispensing Form 5T - Application for Trainee
Permit
( 51
KB)
Optometry
- Optometry Form 1 - Application for Licensure
( 42
KB)
- Optometry Form 2 - Certification of Professional Education
( 28
KB)
- Optometry Form 3 - Verification of Licensure/Certification
in Another Jurisdiction
( 26
KB)
- Optometry Form 4 - Report of Professional Practice
( 16
KB)
- Optometry Form 4A - Supporting Affidavit of Professional
Practice
( 22
KB)
Perfusion
- Perfusionist Form 5 - Application for Permit
( 23 KB)
- Perfusionist Form 5A - Verification of Employment by Hospital
( 13 KB)
Pharmacy
- Pharmacist
- Pharmacist Form 1 - Application for Licensure & First Registration
( 39
KB)
- Pharmacist Form 2 - Certification of Professional
Education
( 27
KB)
- Pharmacist Form 4 - Certification of an Internship in Pharmacy
( 32 KB)
- Pharmacist Form 4B - Certification of Completion of Pharmacy Practice Residency Competencies
( 32 KB)
- Pharmacist Form 5 - Application for a Limited (Intern)
Permit
( 32
KB)
- Pharmacist Immunization - Application for Certification
( 17
KB)
- Pharmacist Form 1 - Application for Licensure & First Registration
(
- Pharmacy Establishment
Physical Therapy
- Physical Therapy Form 1 - Application for Licensure & First Registration
( 40
KB)
- Physical Therapy Form 2 - Certification of Professional
Education
( 21
KB)
- Physical Therapy Form 3 - Certification of Physical Therapist
or Physical Therapist Assistant Licensure in Another State
( 74
KB)
- Physical Therapy Form 4 - Endorsement Applicant Professional Experience Record
( 13 KB)
- Physical Therapy Form 4A - Certification of Professional Experience for Endorsement
Applicants
( 18 KB)
- Physical Therapy Form 5 - Application for Limited Permit
( 28
KB)
Podiatry
- Podiatry Form 1 - Application for Licensure & First Registration
( 46
KB)
- Podiatry Form 2 - Certification of Professional Education
( 26
KB)
- Podiatry Form 3 - Certification of Podiatry License in
Another Jurisdiction
( 23
KB)
- Podiatry Form 4pgy - Certification of Approved Podiatric
Postgraduate Training
( 24
KB)
- Podiatry Form 5A - Application for a Limited Permit for
Applicants Who Have Applied for Licensure in New York
( 41
KB)
- Podiatry Form 5B - Application for a Limited Permit for
Applicants Who Have Not Applied for Licensure in New York
( 146
KB)
- Podiatry Form 5C - Application for a Limited Residency
Permit for Applicants Who Are Applying forLicensure in New York
( 47
KB)
- Podiatry Form 5D - Application for a Limited Residency
Permit for Applicants Who Are Not Applying for Licensure in New York
( 147
KB)
Polysomnographic Technology
- Polysomnographic Form 1 - Application for Authorization
( 25
KB)
- Polysomnographic Form 2 - Certification of Professional Education
( 17
KB)
- Polysomnographic Form 3 - Verification of Other Professional Licensure/Certification
( 17
KB)
- Polysomnographic Form 4 - Report of Professional Experience
( 16
KB)
- Polysomnographic Form 4A - Verification of Professional Exiperience
( 18
KB)
- Polysomnographic Form 5 - Application for Limited Permit
( 14
KB)
Psychology
- Psychology Form 1 - Application for Licensure & First Registration
( 40
KB)
- Psychology Form 2 - Certification of Professional Education
( 21
KB)
- Psychology Form 3 - Certification of Out of State Licensure
and Examination Grades
( 34
KB)
- Psychology Form 4 - Report of Professional Experience
( 50
KB)
- Psychology Form 5A - Application for Limited Permit For
Persons Gaining Experience For Licensure
( 21
KB)
- Psychology Form 5B - Application for Limited Permit For
Persons Licensed In Other Jurisdictions
( 19
KB)
Public Accountancy
- CPA Form 1 - Application for Licensure & First Registration
( 41
KB)
- CPA Form 2 - Certification of Professional Education
( 29
KB)
- CPA Form 3 - Certification of Out-of-State Licensure
and Examination Grades
( 24
KB)
- CPA Form 4 - Applicant Experience Record
( 34
KB)
- CPA Form 4B - Certification of Employer
( 24
KB)
- Instructions for Completing Certification of Employer
Form 4b
( 23 KB)
- Form 4E - Applicant Experience Record For Endorsement Applicants ( 19KB)
- CPA Form 6R - Application for Public Accountancy Firm ( 96 KB)
- CPA Form 6C - Certification of Ownership and Attest Competency ( 88 KB)
- CPA Form 6RA - Public Accounting Firm Annual Report Form ( 92 KB)
- CPA Form 6T - CPA Firm Triennial Registration ( 96 KB)
Respiratory Therapy
- Respiratory Therapy Form 1 - Application for Licensure & First Registration
( 42
KB)
- Respiratory Therapy Form 2 - Certification of Professional
Education
( 24
KB)
- Respiratory Therapy Form 5 - Application for Limited
Permit
( 23
KB)
Social Work
Licensed Master Social Worker
- Licensed Master Social Worker Form 1 - Application for
Licensure
( 24
KB)
- Licensed Master Social Worker Form 2 - Certification
of Professional Education
( 17
KB)
- Licensed Master Social Worker Form 3 - Verification of
Other Professional Licensure/Certification
( 18
KB)
- Licensed Master Social Worker Form 4Q - Approval of Qualifications to Supervise Psychotherapy ( 20
KB)
- Licensed Master Social Worker Form 5 - Application for
a Limited Permit
( 18
KB)
- Licensed Master Social Worker Form 6 - Plan for Supervised Experience ( 28
KB)
Licensed Clinical Social Worker
- Licensed Clinical Social Worker Form 1 - Application
for Licensure
( 26
KB)
- Licensed Clinical Social Worker Form 2 - Certification
of Professional Education
( 20
KB)
- Licensed Clinical Social Worker Form 3 - Verification
of Other Professional Licensure/Certification ( 18
KB)
- Licensed Clinical Social Worker Form 4 - Applicant Experience Record
( 11
KB)
- Licensed Clinical Social Worker Form 4B - Certification
of Experience for Licensed Clinical Social Worker
( 23
KB)
- Licnesed Clinical Social Worker Form 4E - Endorsement Applicant Experience Record ( 14
KB)
- Licnesed Clinical Social Worker Form 4F - Certification of Licensed Experience ( 19
KB)
- Licensed Clinical Social Worker Form 4Q - Approval of Qualifications to Supervise Psychotherapy
( 20
KB)
- Licensed Clinical Social Worker Form 5 - Application
for Limited Permit
( 20
KB)
- Licensed Clinical Social Worker Form 6 - Plan for Supervised Experience ( 22
KB)
Psychotherapy Privilege
- Social Work Psychotherapy Privilege Form 1SWPR - Application
for Licensed Clinical Social Worker Psychotherapy "R" Privilege ( 17
KB)
- Social Work Psychotherapy Privilege Form 4SWPR - Certification of Experience for Licensed Clinical Social Worker Psychotherapy "R" Privilege
( 23
KB)
- Social Work Psychotherapy Privilege Form 4q-SWPR - Approval of Qualifications to Supervise Psychotherapy ( 20
KB)
- Social Work Psychotherapy Privilege Form 6SWPR - Plan for Post-LCSW Supervised Experience ( 22
KB)
Speech-Language Pathology and Audiology
- Speech-Language Pathology and Audiology Form 1 - Application
for Licensure
( 44 KB)
- Speech-Language Pathology and Audiology Form 2 - Certification
of Professional Education
( 22
KB)
- Speech-Language Pathology and Audiology Form 3 - Verification of Other Professional Licensure/Certification ( 18 KB)
- Speech-Language Pathology and Audiology Form 4a - Identification
of Supervisor and Setting
( 18
KB)
- Speech-Language Pathology and Audiology Form 4b - Record
of Supervised Experience
( 18
KB)
Veterinary Medicine
- Veterinarian
- Veterinary Medicine Form 1 - Application for Licensure & First Registration
( 43
KB)
- Veterinary Medicine Form 1LL - Application for a
Three-year Limited License
( 29
KB)
- Veterinary Medicine Form 2 - Certification of Professional
Education
( 30
KB)
- Veterinary Medicine Form 2PPE - Certification of
Pre-professional Education
( 20
KB)
- Veterinary Medicine Form 2CT - Certification of Clinical
Training
( 22
KB)
- Veterinary Medicine Form 3 - Verification of Out-of-state
Licensure, Registration, and/or Examination
( 23
KB)
- Veterinary Medicine Form 4 - Verification of Professional
Practice
( 20
KB)
- Veterinary Medicine Form 5 - Application for Limited
Permit
( 26
KB)
- Veterinary Medicine Form 1 - Application for Licensure & First Registration
(
- Veterinary
Technician
- Veterinary Technology Form 1 - Application for Licensure & First Registration
( 41
KB)
- Veterinary Technology Form 1LL - Application for
a Three-year Limited License and Extension
( 29
KB)
- Veterinary Technology Form 2 - Certification of Professional
Education
( 28
KB)
- Veterinary Technology Form 3 - Verification of Out-of-state
Licensure, Registration, and/or Examination
( 23
KB)
- Veterinary Technology Form 4 - Verification of Professional
Practice
( 20
KB)
- Veterinary Technology Form 5 - Application for Limited
Permit
( 28
KB)
- Veterinary Technology Form 1 - Application for Licensure & First Registration
(
Non-Profession Specific Forms
- Address/Name Change Form
( 67 KB)
- Application for State Board Membership
( 248 KB)
- Attestation of Infection Control Training
( 11 KB)
- Child Support Obligation Form
( 17 KB)
- Citizenship and Immigration Status Form
( 25 KB)
- Mandated Training Related to Child Abuse - Certificate
of Exemption Form
( 15 KB)
- Mandatory Continuing Education Questionnaire for Delayed
Registration
( 57 KB)
- Professional Assistance Program Application
( 85 KB)
- Professional Discipline Complaint Form
( 29 KB)
- Request for Reasonable Testing Accommodations
( 23 KB)
- Request for Written Confirmation of NYS Licensure
( 16 KB)
- Student Loan Disclosure Form
( 23 KB)
Last Updated:
December 20, 2012
