License Application Forms
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- Form 1 - Application for Licensure ( 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 our customer services unit to request a Delayed Registration Application by e-mailing: firstname.lastname@example.org, 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 $108 licensure and first registration fee directly to the Office
of the Professions at the mailing address at the bottom 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 ( 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 in Ophthalmic Dispensing - ( 25 KB)
- This form must be submitted
directly by the educational institution you attended.
- Section I: Complete this section of the form before sending it to your school. Be sure to sign and date item 7.
- Section II: The Registrar or appropriate school official must complete this section and return the form in a school envelope directly to the Office of the Professions at the mailing address at the end of the form.
NOTE: For programs that are not registered by the New York State Education Department as licensure qualifying, or, if outside New York State, not accredited by the Commission on Opticianry Accreditation (COA), an official transcript and a syllabus of the course of study must be included.
- Form 3 - Certification of Ophthalmic Dispensing Licensure in Another Jurisdiction - ( 24 KB)
- This is only required for applicants licensed in another
state or U.S. territory.
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 an ophthalmic dispenser. Be sure to sign and date item 8.
- 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 at the end of the form.
- Form 4 - Certification of Trainee Experience in Ophthalmic Dispensing And/Or Contact Lens Dispensing - (If applicable, 15 KB)
- If you have completed a two-year training program in ophthalmic dispensing approved by the New York State Education Department or a one-year training program in contact lens dispensing approved by the Department, complete Section I of this form and submit it to the individuals(s) who supervised your trainee experience. They must then complete Section II and submit the form directly to the Office of the Professions at the address at the end of the form.
Additional Required Documentation
Applicants for ophthalmic dispensing licensure who have met the professional education requirement through an approved traineeship must also submit a certificate from the National Academy of Opticianry documenting completion of the Career Progression Program. In addition, the Department must have on file a high school transcript documenting completion of one year of mathematics such as algebra or geometry.
Applicants for certification in contact lens dispensing who have met the professional education requirement through an approved traineeship must also submit a certificate from the Contact Lens Society of America documenting completion of the Contact Lens Study Manual.
These certificates must be submitted directly by the issuing organization and will not be accepted if submitted by the applicant.
- Form 5 - Application for Limited Permit - (If applicable) ( 31 KB)
- If you are seeking a limited permit, complete Section I and have your supervisor complete and sign Section II, and submit it with the $35 fee for a limited permit in ophthalmic dispensing and/or the $35 fee for a limited permit in contact lens dispensing to the address indicated at the end of the form. You must meet all other requirements for licensure, except the examination requirement, to be eligible for a limited permit. (This includes filing the Form 1 and licensure application fee.)
- Form 5T - Application for Trainee Permit - ( 54 KB)
- Only use this form if you are applying for a Trainee
Permit in Ophthalmic Dispensing and/or Contact Lens
Complete this form and submit it with a $30 fee for the ophthalmic dispensing trainee permit and/or a $30 fee for the contact lens trainee permit directly to the Office of the Professions at the address at the end of the form. Please note that this form includes separate attestation sections for supervisors of ophthalmic dispensing trainees and contact lens dispensing trainees. A social security number is not required for a permit. If you do not have one, leave the item blank.
Documentation Of Enrollment In A Training Program
If you are seeking a trainee permit in ophthalmic dispensing, you must have the National Academy of Opticianry send us a letter indicating your purchase and enrollment in the Career Progression Program.
If you are seeking a trainee permit in contact lens dispensing, you must have the Contact Lens Society of America send a letter indicating your purchase and enrollment in the Contact Lens Study Manual program.
Documentation Of High School And Mathematics Completion
If you are applying for an ophthalmic dispensing trainee permit, you must ask your high school to send a copy of your high school transcript documenting completion of one year of mathematics such as algebra or geometry directly to:
The New York State Education Department
Office of the Professions
Division of Professional Licensing Services
Ophthalmic Dispensing Unit
89 Washington Avenue
Albany, NY 12234-1000.
Completion of general or business math will not meet this requirement.
NOTE: The Office of the Professions will not accept a high school transcript if it is submitted by the applicant.