License Application Forms
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- Form 1 - Application
for Licensure (
Important Notice: 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 our customer services unit to request a Delayed Registration Application by e-mailing: firstname.lastname@example.org, or by calling 518-474-3817 Ext. 570. When e-mailing, be sure to include your profession, license number, address on record, new address (if changed), date of birth and the last 4 digits of your SSN.
- All applicants for licensure must complete this form and submit it
with the $294 licensure and first 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 -
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 Education - ( 15 KB)
- This form must be submitted
directly by the professional school.
- Section I: Complete this section and send the form to the professional school where you completed your chiropractic educational program.
- Section II: The Registrar or appropriate school official must complete this section and return the form directly to the Office of the Professions at the address at the end of the form together with an official transcript.
Transcripts are required from each preprofessional college or postsecondary school attended.
- Form 3 - Verification of Chiropractic Licensure in Another Jurisdiction - ( 18 KB)
- This form must be submitted directly by the licensing authority.
Use this form if you are or ever have been licensed in another U.S. jurisdiction.
- Section I: Complete this section and forward this form to the licensing authority of the jurisdiction in which you passed the State licensure examination. Ask the licensing authority to complete Section II and submit the completed form directly to the Office of the Professions at the address at the end of the form.
- Section II: An official from the licensing authority must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.
NOTE: A separate Form 3 must be received from every state, province or country in which you are or ever have been licensed.
- Form 4 - Verification
of Experience - ( 15 KB)
This form must be submitted directly by at least two licensed professional colleagues.
- Section I: Complete this section and forward this form to at least two licensed professional colleagues to complete section II.
- Section II: Ask your professional colleagues to complete Section II and submit the completed form directly to the Office of the Professions at the address at the end of the form.
NOTE: A separate Form 4 must be received from each licensed colleague verifying your professional experience.