License Application Forms: Clinical Nurse Specialist

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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Form 1 - Application for a Clinical Nurse Specialist Certificate ( PDF 22 KB)
All applicants for a certificate must complete this form and submit it with the $80 fee for a certificate and initial registration directly to the Office of the Professions at the 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.

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 (If applicable) ( PDF 17 KB)

For applicants who have completed a program registered by the State Education Department as qualifying for a certificate or a program determined by the Department to be equivalent.

This form must be submitted directly to the Office of the Professions by the professional school you attended. This form will not be accepted if submitted by the applicant or any party other than the school official.

  • Section I: Complete this section of the form before sending the entire form to your school. Be sure to sign and date item 11.
  • Section II: The Registrar must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

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.
  • 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.

Form 3 - Verification of Other Professional Licensure/Certification ( PDF 17 KB)
Complete this form if you hold, or have ever held, a license or certificate to practice as a clinical nurse specialist in any jurisdiction.

This form must be submitted directly by the licensing/certifying authority. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section before sending the entire form to the licensing/certifying authority of each jurisdiction in which you are or have been licensed/certified. Be sure to sign and date item 9.
  • Section II: The licensing/certifying authority must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

Form 3C - Verification of Clinical Nurse Specialist Certification ( PDF 16 KB)

For applicants seeking a New York State clinical nurse specialist certificate through a national certifying organization.

This form must be submitted directly to the Office of the Professions from the national certifying organization that will verify your certification. The Office of the Professions will not accept this form if submitted by the applicant or any other party.

  • Section I: Complete this section before sending the entire form to the national certifying organization to verify that you are certified. Be sure to sign and date item 9.
  • Section II: The national certifying organization must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.
Last Updated: November 13, 2019