License Application Forms
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.
- Form 1 - Application for Licensure/Authorization ( 41 KB)
- 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 ( 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 - ( 22 KB)
- This form must be submitted directly from the professional school.
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 email@example.com 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 - ( 18 KB)
- Complete this form if you hold, or have ever held,
a license or certificate to practice any profession* in
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 - ( 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.