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.
Form 1 - Application for Licensure & First Registration ( PDF 42 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 the Registration and Fees Unit to request a Delayed Registration Application by e-mailing: OPREGFEE@mail.nysed.gov, or by calling 518-474-3817 Ext. 410.  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 for licensure must complete and submit this form with the 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. 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 23 KB)
This form must be submitted directly from the educational institution.
  • Section I: Complete this section of the form before sending it to your educational institution. Be sure to sign and date item 9 and include any required fees.
  • Section II: The Registrar must complete this section and return the form in a sealed school envelope directly to the Office of the Professions at the mailing address at the end of the form. If you completed a non-New York State licensure-qualifying program, the educational institution must attach an official school transcript to the form.

Form 3 - Verification of Out-of-State Licensure or Registration - ( PDF 22 KB)
This is only required for applicants licensed in another state, territory or country.

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 as a massage therapist. Be sure to 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 mailing address on the form. A separate Form 3 must be submitted from each jurisdiction where a license was issued.

Form 4 - Report of Professional Experience ( PDF 20 KB)
This is only required for applicants licensed in another state, territory or country who are seeking licensure by endorsement in New York State.
  • Section I: Complete this section in ink.
  • Section II: Provide an accurate and complete record of your professional work experience in chronological order. Include the name and address of your employer, co-workers or colleagues who will attest to your experience. Sign and date the attestation and send the form to the Office of the Professions at the address at the end of the form.

Form 4B - Verification of Experience ( PDF 31 KB)
This is only required for applicants licensed in another state, territory or country who are seeking licensure by endorsement in New York State.

This form must be submitted directly from the individual verifying the applicant's professional work experience.

  • Section I: Complete this section in ink. Be sure to sign and date the attestation. Send the form to the employer, co-worker or colleagues who will verify your work experience.
  • Section II: Have your employer, co-worker, or colleagues who will attest to your experience complete Section II, sign, date and send 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 27 KB)
  • Section I: Complete this section in ink. Be sure to sign and date item 10. Submit to your supervisor to complete Section II.
  • Section II: Have your supervisor complete this section, sign and date the attestation and send the form directly to the Office of the Professions at the address at the end of this form.

NOTE: If you have not yet submitted an application for massage therapy licensure (Form 1 and fee) you must do so before your limited permit application can be evaluated. Your permit cannot be issued until we receive and approve all required documentation. You may not begin practice until your limited permit is issued.

Last Updated: April 8, 2014