License Application Forms

Physician Assistant

Important Notice: DO NOT use Form 1 if you are already licensed in this profession in New York State. 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. To renew your registration online, visit www.op.nysed.gov/renewalinfo.htm. If your registration has lapsed, contact us to request a Delayed Registration Application, or call 518-474-3817 Ext. 570.

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Online Form 1 - Application for Licensure
All applicants for licensure must initially submit Form 1 along with the $115 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.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

Change Address or Name  - You are required to notify us within 30 days of any address or name changes. Please read the instructions to request this change.

Form 2 - Certification of Professional Education ( PDF 23 KB)
This form must be submitted directly by the professional school you attended.

  • Section I: Complete this section of the form. Be sure to sign and date item 8 before sending it to your professional school.
  • Section II: Request the professional school to complete this section and attach an official transcript and send it directly to the Office of the Professions at the address at the end of the form. Be sure to include any fee required by the school.

Electronic Transcript Service

The Office of the Professions (OP) will accept official electronic transcripts from educational institutions (i.e. colleges/universities) or designated third-party* transcript entities located in the United States provided that:

  • The transcript is the certified true and official academic record and the document does NOT have an expiration date**.
  • OP can independently verify that the transcript is received directly from the educational institution’s registrar or officially designated third-party.
  • If a third-party transcript provider is involved, it is clear that the educational institution has designated the third party as the official sole provider of its transcripts.
  • The applicant had no opportunity to directly access or alter the transcript before it is sent or transmitted.
  • Any educational institution transcript submissions should be made electronically to DPLSEduc@nysed.gov***.

*OP will only accept third-party submissions after we have determined that the arrangement between the educational institution and the third party is consistent with our security and verification standards.

**Transcript documents with expiration dates cannot be accepted. Expirations on links to the document are acceptable.

***Do NOT use this email to submit a question, as we will be unable to provide a response. Submit a Contact Us Form for questions regarding specific applications or to check the status of a licensure application.

Form 3 - Verification of Licensure/Certification in Another Jurisdiction ( PDF 22 KB)
Use this form only if you are or have been licensed/certified in another jurisdiction

This form must be submitted directly by the licensing authority.

  • Section I: Complete this section of the form before sending it to the licensing authority of each jurisdiction in which you are or have been licensed/certified. Be sure to include any fee required by the licensing authority and sign and date item 7.
  • Section II: The licensing authority must complete this section, sign, date and return the form directly to the Office of the Professions at the address at the end of the form.

Form 5 - Application for Limited Permit ( PDF 26 KB)

  • Section I: Complete this section of the form before sending it to your employer. Be sure to sign and date item 8 and include your limited permit fee of $105. If you have not yet filed the licensure application (Form 1) and fee, and any additional required documentation, you must do so before the Office of the Professions can review and approve your application for a limited permit.
  • Section II: Request the supervising physician to complete this section and return to you. Send this application and fees to the Office of the Professions at the mailing address at the end of the form.
Last Updated: November 13, 2019