License Application Forms

Important Notice: If you were ever licensed 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 by calling 518-474-3817 Ext. 570.

Online Form 1 - Application for Licensure
All applicants for licensure must initially submit Form 1 along with the $322 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.

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 23 KB)
This form must be submitted directly by the professional school you attended.
  • Section I: Complete this section of the form before sending it to the professional school(s) verifying your professional education. Be sure to sign and date item 8. Send this form to the school(s) you attended and ask them to complete the appropriate section of the form. Be sure to include any fee required by the school. A separate Certification of Professional Education must be submitted for each educational program attended.
  • Section II: The Registrar must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.

Note: If you graduated after December, 1995, completed the pharmacology and law courses at the same institution where you completed your New York State registered, licensure qualifying midwifery program, AND that institution is located in New York State, you do NOT have to complete either Form 2A or Form 2B. If the institution is located outside of New York State, you must still complete a Form 2B.

Form 2A - Certification Of Pharmacology Course Or The Equivalent Of Not Less Than Three Semester Hours - ( PDF 22 KB)
This form must be submitted directly by the institution providing the pharmacology course.
 
  • Section I: Complete this section of the form. Be sure to sign and date item 7 and send it to the institution that provided the pharmacology course. Ask the institution to verify your attendance at the three-hour pharmacology course (or equivalent) by completing the appropriate section of the form. Be sure to include any fee required.
  • Section II: The Registrar must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.
 
Form 2B - Certification Of Instruction In New York State And Federal Laws Relating To Prescriptions And Record Keeping - ( PDF 22 KB)
This form must be submitted directly by the institution/organization providing the instruction in New York State and federal laws relating to prescriptions and record keeping.
 
  • Section I: Complete this section of the form. Be sure to sign and date item 7 and send it to the institution/organization that provided the instruction in New York State and federal laws relating to prescriptions and record keeping. Ask the institution/organization to verify your completion on the appropriate section of the form. Be sure to include any fee required.
  • Section II: The Registrar or appropriate institution/organization official must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.
 

Form 5 - Application for Limted Permit - ( PDF 25 KB)

You may apply for a limited permit by submitting the Application for Limited Permit (Form 5) and limited permit fee of $70 at the same time or any time after you submit your application for licensure (Form 1), licensure fee of $322, and evidence of satisfactory education. The limited permit is valid for a period of one year and may not be renewed. The State Education Department must approve your education before your application for a limited permit can be approved.
 
  • Section I: Complete this section and be sure to sign and date item 10.
  • Section II: Ask your prospective employer to complete this section.
Last Updated: June 25, 2018