Application Forms: RN & LPN
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.
Please type or print all information and sign all forms in black or blue ink. Original signatures are required on all forms.
- Form 1 - Application for Licensure
Submit Online Form 1; or
Download PDF Form 1 ( 54 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 our customer services unit to request a Delayed Registration Application by e-mailing: email@example.com, or by calling 518-474-3817 Ext. 570. 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 this
form and submit it with the $143 licensure and first registration
fee 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.
If you are applying for licensure as a licensed practical nurse and you did not graduate from a New York State approved nursing program, you must submit a copy of your high school or secondary school diploma or transcript in the original language with your Form 1.
If you were educated outside the U.S., submit a copy of your nursing diploma in the original language.
- 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 (If applicable) ( 28 KB)
- This form must be submitted directly by the nursing school that made you eligible to take the NCLEX examination. The Office of the Professions will not accept this form if submitted by the applicant.
- If you graduated after April 1, 1998 from a New York State licensure qualifying program registered by the State Education Department, your school will notify us of your educational qualifications. You do not have to submit Form 2.
- If you completed a New York State licensure qualifying program prior to April 1, 1998, or obtained your education in the United States but not in New York State, complete Section I of Form 2 and forward the entire form to your school of nursing to complete and submit directly to the State Education Department.
- If your education was obtained in another country, do not
use Form 2. You must have your educational credentials verified
by CGFNS, an independent credentials verification organization, before
the New York State Education Department can determine if your credentials
meet New York State's requirements for licensure. See "Verifying
Education Credentials From Non-U.S. Programs". Contact CGFNS
for the forms and procedures for the independent verification of
your education credentials (see contact
- Form 2AF - Certification Of Equivalent U.S. Armed Forces Education For LPN Licensure ( 26 KB)
- Complete this form ONLY if you are applying for
an LPN license based on completion of equivalent education
in a program conducted by the U.S. armed forces.
The Office of the Professions will not accept this form if submitted by the applicant.
- Section I: Complete this section of the form and forward the entire form to the U.S. armed forces program to complete and submit directly to the Office of the Professions at the mailing address on the form.
- Section II: The U.S. armed forces program must complete
this section, sign, date and return both pages of the
form directly to the Office of the Professions with an
official transcript in a sealed armed forces envelope.
- Form 3 - Verification of Other Professional Licensure/Certification ( 34 KB)
- Complete this form if you hold, or have ever held,
a license or certificate to practice any profession* in
any jurisdiction. For additional information on verifying
nurse licensure, see Verification
of Nurse Licensure in Another State.
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.
NOTE: A Form 3 is not required for licenses/certificates issued by the New York State Education Department.
*Profession is defined as professional titles licensed under New York State Education Law.
- Form 5 -
Application for Limited Permit ( 36 KB)
- Section I: If you are applying for a limited permit, complete this section before asking your prospective employer to complete Section II.
- Section II: Ask your prospective employer to complete this section.
You may apply for a limited permit either at the same time as or after submitting an Application for Licensure (Form 1) and the licensure fee of $143. If you have not yet filed a Form 1 and the licensure fee, you must submit them with the Form 5 and the limited permit fee of $35.
Return all 3 pages of the completed form with the $35 fee to the Office of the Professions at the address at the end of the form. You must meet all requirements for licensure, except the examination requirement, to be eligible for a limited permit. RN applicants - If you did not complete the required coursework or training in the identification and reporting of child abuse as part of a New York State educational program, you must submit a certificate of completion from an approved provider or a Certification of Exemption (Form 1CE).
- Child Abuse Certification of Exemption Form - ( 21 KB)
- This form is not for all applicants. Use this form only if you are applying for an exemption to the requirement to complete training or coursework in the identification of child abuse and maltreatment because the nature of your practice excludes contact with persons under the age of 18 and persons 18 or older with a handicapping condition who reside in a residential care school or facility.
- You may register online directly with the examination provider, VUE , the electronic testing service of NCS Pearson, to take NCLEX.