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 the $294 licensure and registration fee for Respiratory Therapist or $154 for Respiratory Therapy Technician. 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 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 3 - Verification of Other Professional Licensure/Certification - ( PDF 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 appropriate licensing/certifying authority. Be sure to sign and date item 9. A separate Form 3 must be submitted for all licenses/certificates you have ever held except those issued by the New York State Education Department.
  • 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 ( PDF 20 KB) for a list of those titles.)

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: November 28, 2018