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 External Link Icon installed on your computer. Download times and print quality will depend on your connection speed and printer.

Individual Forms

Form 1 - Application for Licensure and First Registration ( PDF 40 KB)

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:, 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 applying for licensure through the grandparent provision or endorsement must complete this form and submit it with the appropriate fee ($430) 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 2 - Certification of Professional Education (PDF 22 KB)
This form must be submitted directly by the educational institution. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section and be sure to sign and date item 8.
  • Section II: Send the entire form to the educational institution(s) you attended and ask that they complete Section II and return all pages of the form along with any required documentation* directly to the Office of the Professions at the address at the end of the form.

*Be sure to ask your school to attach an official transcript or marksheet if you completed a program not registered by the New York State Education Department as licensure qualifying

Form 3 - Verification of Out-of-State Licensure, Registration and/or Examination ( PDF 25 KB)

The Office of the Professions will not accept this form if submitted by the applicant.

           1. Use this form to verify licensure in another jurisdiction. This jurisdiction should be:
             • Your primary place of practice. If this jurisdiction does not license geologists then
             • The jurisdiction of original licensure.

Complete section I of this form and be sure to sign and date item 9. Then send this   form to the jurisdiction and ask that they complete section II and return the form directly to the Office of the Professions.

2. Use this form to verify that you passed the Fundamentals of Geology examination and/or the Practice of Geology examination in another jurisdiction. Complete Section I of this form and be sure to sign and date item 9. Then send this form to the jurisdiction(s) from which you wish to have examination grades transferred or to ASBOG, and ask that they complete section II and return the form directly to the Office of the Professions.

Form 4 - Report of Professional Experience (PDF 23 KB)

Form 4A - Verification of Professional Experience (Print as many as needed) (PDF 25 KB)
Instructions For Completing Report of Professional Experience and Verification of Professional Experience 4 and 4A | PDF ( PDF 19 KB). See these instructions for additional information to document your geology experience.

New York State Institutions/Schools - ONLY

Geology Program Proposal Application Form

For those New York State institutions/schools who wish to register their professional geology educational programs, with the New York State Education Department as a licensure qualifying program, please use this link to the memorandum outlining curricular requirements.

Registration as a licensure qualifying program means that students that meet the requirement of the Commissioner’s Regulations 68.9(d.)(1) – [are within 20 credits of graduation from a bachelor’s degree program in geological sciences registered as leading to licensure pursuant to section 52.46 of this Title] are eligible to sit for the ASBOG Fundamentals of Geology Examination (FG) after submitting an applicant and obtaining approval by NYSED Office of Professions. Colleges and universities with licensure qualifying programs are listed on the NYSED web page in the Inventory of Registered Programs and can be easily accessed by potential students doing their college searches.

Click on these links to “The Commissioners Regulations on Program Registration” and “Guidelines on Meeting Professional Education Requirements in Geology” to find additional information to assist schools wishing to become a registered professional program in geology. This information is intended for use by New York State Colleges/Universities and not by individuals seeking to become a licensed geologist.


Last Updated: December 21, 2016