License Application Forms
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- Form 1 - Application for Authorization ( 25 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 our customer services unit to request a Delayed Registration Application by e-mailing: email@example.com, or by calling 518-474-3817 Ext. 570. 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 authorization to practice as a polysomnographic technologist must complete this form and submit it
with the $600 fee for authorization and first registration 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)
- 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 - ( 17 KB)
- This form must be submitted directly by the professional school.
- Section I: Complete this section of the form before sending it to your school. Please be sure to sign and date item 9.
- Section II:Send the entire form to the institution(s) you attended and ask the registrar to complete Section II and forward all pages of the form directly to the Office of the Professions at the address at the end of this form. Be sure to include any fee required by the institution. This form will not be accepted if submitted by the applicant.
- Form 3 - Verification of Other Professional Licensure/Certification - ( 17 KB)
- 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.
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. (See page 2 of the Address/Name Change Form ( 20 KB) for a list of those titles.)
- Form 5 - Application for Limited Permit - ( 18 KB)
- Section I: Complete this section of the form. Please be sure to sign and date item 9.
- Section II: Your prospective supervisor must complete this section. You must meet all other requirements for licensure except the examination requirement, in order to be eligible for a limited permit.
In addition to the Form 5 and $70 limited permit fee, you must also submit the Application for Authorization (Form 1), the $600 fee for authorization and first registration, and have the State Education Department approve your education before your application for a limited permit can be approved. Return the completed Form 5 to the Office of the Professions at the address at the end of the form.
Note: If the physician providing direction and supervision is not also the individual providing direct and immediate supervision, you will need to submit a separate Form 5 for each.