License Application Forms

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.

Form 1 - Application for Licensure & First Registration ( 23 KB)

ll applicants for licensure must complete this form and submit it with the $103 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.

Address/Name Change Form - Optional ( 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 Professional Education - ( 19 KB)

This form must be submitted directly by the educational institution(s) you attended. 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 your school. Be sure to sign and date item 9.
• Section II: The Registrar must complete this section and return all pages of the form in an official school envelope with requested documents directly to the Office of the Professions at the address at the end of the form.

Note: If you graduated from a high school in the United States, your professional school will attest to your high school/secondary education on this form. No further documentation is normally required.

However, if you completed your high school/secondary school outside the United States, you will need to document your secondary education. You must verify your secondary school diploma or graduation certificate to the Bureau of Comparative Education in one of the following ways:

• Send the original and a photocopy by registered mail to:

  New York State Education Department
  Office of the Professions
  Division of Professional Licensing Services
  Dental Assisting Unit
  89 Washington Avenue
  Albany, NY 12234-1000

  We will return your original to you.

• Bring your original and a photocopy in person to one of the following addresses to have the copy verified:

  New York State Education Department
  Office of the Professions
  Bureau of Comparative Education
  89 Washington Avenue, 2nd Floor
  Albany, NY 12234-1000
  
  New York State Education Department
  Office of the Professions
  Office of Professional Discipline
  475 Park Avenue South, 2nd Floor*
  New York, NY 10016
  *(between 31st and 32nd Streets)

Form 5 - Application for Limited Permit - ( 18 KB)

• Section I: If you are applying for a limited permit, complete this section before having your prospective supervisor complete Section II. Be sure to sign and date item 9.
• Section II: Your prospective supervisor completes this section.

Return the completed form with the $40 fee to the Office of the Professions at the address at the end of the form. If you have not already, you must also submit the Application for Licensure (Form 1), the $103 fee for licensure and first registration, and have your academic institution submit the Certification of Professional Education (Form 2) before your application for a limited permit can be approved.