License Application Forms

Instructions for completing and submitting the forms required for licensure appear below. You may also need to submit additional information (for example, examination scores). Please refer to the license requirements link on the left for complete information regarding all requirements you must meet.

Note: All forms are in Adobe Portable Document Format (PDF). To view or print these documents, you will need to have the free Adobe Reader External Link Icon installed on your computer. Download times and print quality will depend on your connection speed and printer.
Form 1 - Application for Licensure ( PDF 45 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 the Registration and Fees Unit to request a Delayed Registration Application by e-mailing: OPREGFEE@nysed.gov, or by calling 518-474-3817 Ext. 410.  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 licensure must complete this form and submit it with the $294 licensure and registration fee for Respiratory Therapist or $154 for Respiratory Therapy Technician 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 ( 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 23 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: The Registrar or appropriate school official must complete this section and return the form directly to the Office of the Professions at the address at the end of the form. For graduates of NYS licensure qualifying or CoARC accredited programs, Part B, Section I must be completed. For graduates of non-NYS licensure-qualifying or non-CoARC accredited programs and for technician graduates applying for licensure in respiratory therapy, Part B, Section II must be completed and official transcripts and other needed documents submitted.

Form 5 - Application for Limted Permit - ( PDF 34 KB)
  • Section I: Complete this section of the form. Please be sure to sign and date item 9.
  • Section II: Your prospective employer 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 fee, you must also submit the Application for Licensure (Form 1), the licensure fee, 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.

Last Updated: October 2, 2014