License Application Forms

Important Notice: If you were ever licensed in this profession in New York State STOP. 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 us to request a Delayed Registration Application, or call 518-474-3817 Ext. 570.

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Online Form 1 - Application for Licensure
All applicants for licensure must initially submit Form 1 along with the $294 (physical therapist) or $103 (physical therapy assistant) 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.

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 13 KB)
This form must be submitted directly from the educational institution you attended.

  1. If you are a graduate of a program registered by the New York State Education Department as licensure qualifying or accredited by the American Physical Therapy Association (APTA), you must complete Form 2 as follows:
    1. Section l: Complete this section of the form before sending it to your educational institution, then forward this form to your academic institution for completion of Section ll, Part A and Part B. Be sure to sign and date item 8.
    2. Section ll: Have your school complete this section and forward it directly to the Office of the Professions. The Registrar or appropriate school official must return the completed form directly to the State Education Department, Office of the Professions, Division of Professional Licensing Services, Physical Therapy Unit, 89 Washington Avenue, Albany, NY 12234-1000.
  2. If you are applying for licensure based upon an education program that is outside the United States and NOT accredited by the American Physical Therapy Association (APTA), do not use Form 2. You must have your educational credentials verified by an independent credentials verification organization. Please refer to the "Education Requirements" section for the proper procedure.

Form 3 - Certification of Physical Therapist or Physical Therapist Assistant Licensure in Another State (PDF 14 KB)
If you are or have been licensed as a physical therapist or physical therapist assistant in another state or U.S. territory, you must also submit Form 3 to verify your license. A separate Form 3 must be sent directly from each jurisdiction in which you currently or previously held a license.

  • Section I: Complete this section of the form before sending it to the licensing authority. Make sure to include any fee required by that licensing authority for the certification or verification of a license. Be sure to sign and date item 7.
  • Section II: The state or U.S. territory in which you have previously applied for a license or been issued a license must complete this section and forward it directly to The Office of the Professions. The licensing authority must apply an original signature and stamp or seal and return the form directly to:

    The NYS Education Department
    Office of the Professions
    Division of Professional Licensing Services
    Physical Therapy Unit
    89 Washington Avenue
    Albany, NY 12234-1000.

Form 4 - Endorsement Applicant Professional Experience Record (PDF 13 KB)
This form is for applicants seeking licensure in New York State by endorsement of a license to practice physical therapy issued in another jurisdiction.

Complete and send both pages of this form directly to the Office of the Professions at the address at the end of the form. Be sure to sign and date item 8.

You must also complete a separate Form 4A for each colleague you list on the Endorsement Applicant Professional Experience Record (Form 4).

Form 4A - Certification of Professional Experience for Endorsement Applicants (PDF 18 KB)
This form must be submitted directly by a colleague. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section and send the entire form to your colleague to complete Section II. Be sure to sign and date item 7.
  • Section II: The colleague must complete this section, sign and date the form and return the entire form directly to the Office of the Professions at the mailing address at the end of the form.

Form 5 - Application For Limited Permit (PDF 17 KB)
If you are seeking a limited permit, complete section l of this form, have your employer read section II and complete section III, and submit it with the appropriate fee ($70 for physical therapists, $50 for physical therapist assistants) to the address at the end of the form.

Applicants for a limited permit must complete this form in addition to the Application for Licensure (Form 1). Do not send cash. Make checks or money orders payable to the New York State Education Department.

Last Updated: November 14, 2018