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/Authorization ( PDF 41 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@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 or authorization must complete this form and submit it with the $294 (occupational therapist) or $147 (occupational therapy assistant) licensure/authorization 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)
Use this form if you have had a legal name change or to update your address information in our records.

NOTE: Change of address notifications may be e-mailed, faxed or mailed to the Office of the Professions at the address on the form. Change of name notifications must be notarized and cannot be faxed or e-mailed.

Form 2 - Certification of Professional Education - ( PDF 22 KB)
This form must be submitted directly from the professional school.

Occupational Therapist:

For approved New York State Registered or AOTA Accredited Programs: Complete Section I. Be sure to sign and date item 8 and forward the form to your school. Your school must complete Section II and send the form directly to the Office of the Professions at the address at the end of the form.

Non-AOTA Accredited Programs Outside The U.S.: If your education was obtained in another country, do not use Form 2. You must have your educational credentials verified by an independent credentials verification organization before the New York State Education Department can determine if they meet New York State's requirements for licensure. Refer to the "Education Requirements" section. Contact CGFNS for the form and procedures for the independent verification of your educational credentials.

Non-AOTA Accredited Programs In The U.S.: Contact the Bureau of Comparative Education at comped@nysed.gov or 518-474-3817 ext. 300.

Occupational Therapy Assistant:

For approved New York State Registered or AOTA-Accredited Programs: Complete Section I. Be sure to sign and date item 8 and forward the form to your school to complete Section II.

Form 3 - Verification of Other Professional Licensure/Certification - ( PDF 18 KB)
Complete this form if you hold, or have ever held, a license or certificate to practice any profession* 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 8.
  • 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 Limted Permit - ( PDF 25 KB)
If you are applying for a limited permit to practice as an occupational therapist or occupational therapy assistant, complete Section I of Form 5, have your employer and supervisor complete Section II and submit it with the $70 fee to the address indicated. Application for Licensure/Authorization (Form 1), including the licensure fee of $294, and verification of education must be received prior to, or along with, the application for a limited permit.

Individuals applying for a limited permit who have completed all degree requirements but have not received their degree from a New York State registered/licensure-qualifying or AOTA-accredited program, may request their school to complete a Certification of Professional Education (Form 2) with the "met all requirements" date filled in. If this process is followed, you must re-submit another Certification of Professional Education (Form 2) to the school after the degree has been awarded for verification of receipt of the degree, which is required for licensure.

Your permit cannot be issued until we receive and approve all required documentation. A limited permit is valid for one year and may be renewed for an additional year upon submission of a explanation satisfactory to the Department as to why you failed to become licensed within the year of the original permit.

If you change employment or supervisor after a permit is issued, you must obtain a new permit and, with each prospective employer/supervisor, complete a new Form 5 and return it to the Office of the Professions. A new fee is not required for a permit issued as a result of a change in employment.

Last Updated: April 8, 2014
April 8, 2014