License Application Forms

Specialist Assistant

Important Notice: If you were ever licensed in this profession 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 call 518-474-3817 Ext. 570.

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Form 1 - Application for Licensure ( PDF 38 KB)
All applicants for licensure must complete this form and submit it with the $115 licensure and 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. 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. Form 1 must be signed in the presence of 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 12 KB)
This form must be submitted directly from the professional school you attended.
  • Section I: Complete this section of the form. Be sure to sign and date item 8 and send the form to your school.
  • Section II: Request that your school complete this section and attach an official transcript and mail the form and additional documentation 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.
Form 4 - Certification of Experience ( PDF 12 KB)
This form must be submitted directly from the supervisor certifying your professional experience.
  • Section I: Complete this section of the form. Be sure to sign and date item 10 and send the form to the supervisor with whom you worked to complete Section II of the form. A separate Form 4 should be submitted from each employer/supervisor certifying your experience directly to the Office of the Professions.
Last Updated: December 3, 2018
December 3, 2018