License Application Forms

Specialist Assistant

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 and First Registration ( 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 ( 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 ( 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 ( 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.