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 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 $339 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.

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 21 KB)

This form must be submitted directly by the educational institution.

  • Section I: Complete this section of the form before sending it to your school.
  • Section II: If you graduated from a pharmacy program that was accredited by ACPE, the registrar must complete this section. Applicants who are expected to graduate from these programs should forward this form to their academic institution for completion of Section II. The registrar must return the completed form directly to the New York State Education Department.

NOTE: All pharmacy schools in the United States are currently accredited.

Part B is for all other programs. Applicants who are graduates of these programs should forward this form to their academic institution for completion of Section II. The Registrar must return the completed form directly to the New York State Education Department along with an official transcript.

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***.

*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 4 - Certification of an Internship in Pharmacy ( PDF 25 KB)
This form is not required for PharmD graduates from ACPE or CCAPP accredited programs.

Use Form 4 to certify the completion of the required internship, which can only be performed under an authorized permit. A separate Form 4 is required for each pharmacy, and for each preceptor and should be completed, signed by both intern and preceptor, and returned to the Department at the address at the end of the form. Pharmacy payroll records may be requested during periodic routine audits.

Department must receive Form 4 and approve the internship certification before you will be admitted to Parts II and III of the licensing examination series. The completed Form 1 and Form 4 should be submitted together to the Department before the Part III exam application deadline date. Incomplete forms or failure to comply with the internship requirement will prevent your admission to the exam.

  • Section I: Please complete this section of the form before submitting it to your preceptor pharmacist.
  • Section II: Your preceptor pharmacist must complete this section.
  • Section III: You and your preceptor pharmacist must sign in this section, affirming that the statements in Section I and Section II are true.
  • Section IV: If you are seeking credit for an internship completed in another state, submit this form to the authorized representative of that State's Board of Pharmacy for verification.

Internship Submission Deadlines

If you would like to take the exam in: Your complete application must be postmarked by:
January November 1 of the previous year
June April 1 of the same year

Form 4B - Certification of Completion of Pharmacy Practice Residency Competencies (pharm4b.pdf; 14K; 3 pages)

This form must be submitted directly by the residency program director.*

This form is required for applicants seeking licensure without having taken and passed the Part III Written and Practical (Compounding) examination. This alternate pathway is described in Regulations of the Commissioner of Education, section 63.3 and applies only to those candidates for licensure who have gained the required competencies within a formal, approved pharmacy practice residency.

Applicants who have been unsuccessful on a previous Part III examination CANNOT use this alternate pathway to licensure; they must retake and pass Part III.

  • Section I:  Complete this section of the form before forwarding all three pages of this form to the residency program director and ask that they complete Section II.
  • Section II: Measurement standards (see sample provided on page 3) as well as detailed information on measurement standards utilized for assessment of competencies must be submitted by the pharmacist residency program director along with this form.

The residency program director must submit this form as well as any other required information directly to the Office of the Professions at the address at the end of this form. This form will not be accepted if submitted by the applicant.

* NOTE: A candidate must have completed a minimum of 60 days in the residency program before an application can be submitted on their behalf.

Form 5 - Application for a Limited (Intern) Permit ( PDF 27 KB)

You must obtain an intern permit before engaging in the supervised practice of pharmacy in New York. Answer all questions on Form 5 and send it with your fee of $70 to the New York State Education Department. Be sure to sign item 10 and have your signature notarized by a notary public.

  • If you are a student in an accredited pharmacy program, the school must certify that you have completed at least the third year of a five- or six-year curriculum by completing the back of the Form 5.
  • If you are a graduate from a non-accredited program, do not submit Form 5 until after you have passed NAPLEX (Part I).
Last Updated: November 13, 2019