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 $294 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 19 KB)
This form must be submitted directly from the professional school.

  • Section I: Complete this section of the form before sending it to your educational institution. Be sure to sign and date item 10.
  • Section II: The Registrar must complete this section and return the form with an official transcript in a sealed school envelope directly to the Office of the Professions at the mailing address on 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.

Form 3 - Certification of Out of State Licensure and Examination Grades ( PDF 19 KB)
Use this form only if you are or have been licensed as a psychologist in another jurisdiction.

This form must be submitted directly by the licensing authority.

  • Section I: Complete this section of the form before sending it to the licensing authority of each jurisdiction in which you are or have been licensed as a psychologist. Be sure to sign and date item 8.
  • Section II: The licensing authority must complete this section, sign, date and return the form directly to the Office of the Professions at the mailing address on the form. A separate Form 3 must be submitted from each state where a license was granted.

Form 4 - Report of Professional Experience ( PDF 45 KB)
This form must be submitted directly by the supervising psychologist who provided supervision of the professional experience claimed by the applicant. Please see instructions, also contained on the PDF form, for further information.

  • Section I: Complete this section and send the form and Instructions for Completing the Report of Professional Experience (Form 4) to your supervising psychologist. Be sure to sign and date item 7.
  • Section II and III: The supervising psychologist must complete these sections, sign and date the form and return it directly to the Office of the Professions at the mailing address on the form.

Form 5A - Application for Limited Permit For Persons Gaining Experience For Licensure ( PDF 19 KB)
  • Section I: Complete this section and be sure to sign and date item 9.
  • Sections II and III: The supervising psychologist must review the instructions in Section II, complete Section III and sign and date the form before you return it to the Office of the Professions with your limited permit fee.

Form 5B - Application for Limited Permit For Persons Licensed In Other Jurisdictions ( PDF 19 KB)
  • Section I: Complete this section and be sure to sign and date item 9.

For either Form 5A or Form 5B: Return the completed form with the $70 fee to the Office of the Professions at the mailing address on the bottom of the form. If you have not already submitted your Application for Licensure (Form 1) and fee, you must do so before your limited permit application can be processed.

Last Updated: November 13, 2019