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.

Online Form 1 - Application for Licensure
All applicants for licensure must initially submit Form 1 along with the $294 licensure and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated. Failure to accurately complete all required parts of the application will delay its review. Additional forms below are required based on the licensure requirements of the profession.

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 2 - Certification of Education - ( PDF 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 - ( PDF 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 - ( PDF 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.

Last Updated: July 25, 2018