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, contact us to request a Delayed Registration Application, or call 518-474-3817 Ext. 570.

Note: For fillable PDF forms, Internet Explorer is the recommended browser.

Online Form 1 - Application for Licensure
All applicants for licensure must initially submit Form 1 along with the $200 licensure and first registration 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.

Address/Name Change Form - Optional ( PDF 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 - ( PDF 572 KB)
This form must be submitted directly by the educational institution(s) you attended. 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 your institution(s). Be sure to sign and date item 9.
  • Section II: The Registrar must complete this section and return all pages of the form directly to the Office of the Professions at the address at the end of the form.

Electronic Transcript Service

The Office of the Professions (OP) will accept official electronic transcripts 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 transcript 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 transcript 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.

From 3 - Verification of Other Professional Licensure/Certification - (PDF568KB)
Complete this form if you hold, or 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.

* Profession is defined as one of the professional titles licensed under New York State Education Law.

NOTE: This form is to verify other professional licensure only and should NOT be used to verify New York City Certification of Qualification or any affiliations with professional associations or organizations. A Form 3 is not required for licenses/certificates issued by the New York State Education Department.

Form 4 - Verification of Practice - ( PDF 566 KB)
Use this form only if you are applying for licensure under the Grandparenting Licensure Pathway which is available until November 28, 2019. This form must be submitted directly by the physician* who supervised your performance of the duties of a pathologists' assistant for two of the five years prior to November 28, 2017. 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 supervising physician. Be sure to sign and date item 7.
  • Section II: The supervising physician must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

A separate Form 4 must be submitted for each instance of practice used towards meeting the Grandparenting requirements.

*The supervising physician must be a licensed physician practicing anatomic pathology.

Form 5 - Application for a Limited Permit - ( PDF 569 KB)
  • Section I: If you are applying for a limited permit, complete this section before having your prospective supervising physician* complete Section II. Be sure to sign and date item 9.
  • Section II: Have your supervising physician complete Section II.

Return the completed form with the $105 fee to the Office of the Professions at the address at the end of the form.

*The prospective supervising physician must be a licensed physician practicing anatomic pathology.

Last Updated: September 11, 2019