License Application Forms

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 for longer than 4 months, submit a Delayed Registration Application.
 

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Online Form 1 - Application for Licensure
All applicants for licensure must initially submit Form 1 along with the appropriate 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. Do not use Form 1 to renew your existing license.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

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 - ( PDF 28 KB)
This form must be completed and submitted by the educational institution. The Office of the Professions will not accept this form if it is submitted by the applicant.

  • Section I: Complete this section of the form before sending it to your school. Be sure to sign and date item 9.
  • Section II: The Registrar must complete this section and return the form directly to the Office of the Professions at the mailing address on the form.

Electronic Education Documentation

The Office of the Professions (OP) will accept official electronic transcripts and forms 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 and the document does NOT have an expiration date**.
  • OP can independently verify that the documentation 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 education documentation 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.

**Transcript documents with expiration dates cannot be accepted. Expirations on links to the document are acceptable.

***Do NOT use this email to submit a question, as we will be unable to provide a response. Submit a Contact Us Form for questions regarding specific applications or to check the status of a licensure application.

Form 3 - Verification of Licensure/Certification in Another Jurisdiction - ( PDF 25 KB)
Use this form only if you are or have been licensed/certified in another jurisdiction.

  • 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/certified. Be sure to sign and date item 7 and include any fee required by the licensing authority.
  • Section II: The licensing authority must complete this section, sign, date and return 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. Also, If the certification/verification documentation provided by a U.S. jurisdictions contains the same information requested in the Form 3, completion of a Form 3 for that jurisdiction is not necessary. For certification/verification documentation that does not contain the same information, a Form 3 will need to be completed for that jurisdiction.

Electronic Verification of Licensure, Certification and/or Examination

The Office of the Professions (OP) will accept electronic verifications of licensure, certification and examination completion from other licensing authorities located in the United States provided that:

  • OP can independently authenticate that the verification is received directly from the licensing authority.
  • The applicant had no opportunity to directly access or alter the verification before it is sent or transmitted.
  • Any licensing authority verification submissions should be made electronically to DPLSVerif@nysed.gov.*

*DO NOT use this email to submit a question, as we will be unable to provide a response. Submit a Contact Us Form for questions regarding specific applications or to check the status of a licensure application.

Form 4 - Report of Professional Practice - ( PDF 15 KB)
Use this form only if you are licensed in another jurisdiction and are seeking licensure by endorsement.

Complete this form and provide a chronological list of your professional practice in item 5 including the name and practice address of the licensed optometrist(s) who will attest to your practice. Be sure to sign and date item 6.

You must send a corresponding Form 4A to each optometrist you list in item 5.

Form 4A - Supporting Affidavit of Professional Practice - ( PDF 22 KB)

  • Section I: Complete this section of the form and send it to the licensed optometrist(s) who will verify your professional practice. Be sure to sign and date item 7. You may need to have more than one affidavit submitted for comprehensive certification of the required five years of professional optometry practice. Please photocopy the form as needed
  • Section II: The licensed optometrist(s) who will verify your professional practice must complete and submit the form directly to the Office of the Professions at the address at the end of the form.

Electronic Verification of Experience

The Office of the Professions (OP) will accept experience forms directly from supervisors provided that:

  • OP can independently verify that the documentation is received directly from the supervisor
  • The applicant had no opportunity to directly alter the experience form before it is sent or transmitted.
  • Any experience documentation submissions should be made electronically to DPLSExperience@nysed.gov*.

*Do NOT use this email to submit a question, as we will be unable to provide a response. Submit a Contact Us Form for questions regarding specific applications or to check the status of a licensure application.

Child Abuse Certification of Exemption Form - ( PDF 17 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.
Last Updated: April 9, 2020