License Application Forms

Important Notice: If you were ever licensed in New York State STOP. A New York State professional license is valid for life unless it is revoked, annulled, or suspended by the Board of Regents. To practice in New York State your professional license must be registered. If your registration has lapsed and you need to reregister, do not submit a Form 1. Instead, contact us to request a Delayed Registration Application, or by calling 518-474-3817 Ext. 570.

Form 1 - Application for Licensure ( PDF 41 KB)
All applicants for licensure must complete this form and submit it with the $788 licensure and registration fee directly to the Office of the Professions at the mailing 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.

Address/Name Change Form - Optional ( PDF 20 KB)
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 2A - Certification of Preprofessional College/University Education - ( PDF 22 KB)
This form must be completed and submitted by the educational institution. The Office of the Professions will not accept it if submitted by the applicant.
 
  • Section I: Complete this section of the form before sending it to the school (s) where you completed your preprofessional education.
  • Section II: The school Registrar must complete this section and return the form directly to the Office of the Professions at the mailing address at the end of the form.

The school must attach an official transcript or a notation of all courses you completed. The transcript must bear the original signature of the Registrar and original seal of the school. If you attended more than one school to fulfill the preprofessional education requirement, copy this form and send a copy to each institution.

From 2B - Certification of Professional Acupuncture Education - (PDF22KB)
This form must be completed and submitted by the educational institution. The Office of the Professions will not accept it if submitted by the applicant.
 
  • Section I: Complete this section of the form before sending it to the school(s) where you completed your professional acupuncture education.
  • Section II: The school Registrar must complete this section and return the form directly to the Office of the Professions at the mailing address at the end of the form.

The school must attach an official transcript or a notation of all courses you completed. The transcript must bear the original signature of the Registrar and original seal of the school. If you attended more than one school to fulfill the professional education requirement, copy this form and send a copy to each institution.

Form 3 - Verification of Other Professional Licensure/Certification - ( PDF 17 KB)
Complete this form if you hold, or ever held, a license or certificate to practice any profession* in any jurisdiction. Note: DO NOT use this form to verify certification in Applied Behavior Analysis by a national certifying body.

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 appropriate licensing/certifying authority. Be sure to sign and date item 9. A separate Form 3 must be submitted for all licenses/certificates you have ever held except those issued by the New York State Education Department.
  • 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.

NOTE: A Form 3 is not required for licenses/certificates issued by the New York State Education Department.

*Profession is defined as professional titles licensed under New York State Education Law. (See page 2 of the Address/Name Change Form ( PDF 20 KB) for a list of those titles.)

Form 5 - Application for a Limited Permit - ( PDF 23 KB)
If you are seeking an acupuncture limited permit, complete Section I of this form, have your employer complete Section II, and submit it with the $70 fee to the address indicated at the end of the form. Do not send cash. Make checks or money orders payable to the New York State Education Department. You must also submit the Application for Licensure and First Registration (Form 1), the licensure fee, and have the State Education Department approve your education before your limited permit can be issued.
Last Updated: November 20, 2018