- This form must be submitted directly by the licensing authority.
Use this form if you are or ever have been licensed in another U.S. jurisdiction.
- Section I: Complete this section and forward this form to the licensing authority of the jurisdiction in which you passed the State licensure examination. Ask the licensing authority to complete Section II and submit the completed form directly to the Office of the Professions at the address at the end of the form.
- Section II: An official from the licensing authority must complete this section and return 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. Also, If the certification/verification documentation provided by a U.S. jurisdictions contains the same information requested in the Form 3, completion of a Form 3 for that jurisdiction is not necessary. For certification/verification documentation that does not contain the same information, a Form 3 will need to be completed for that jurisdiction.Electronic Verification of Licensure, Certification and/or Examination
The Office of the Professions (OP) will accept electronic verifications of licensure, certification and examination completion from other licensing authorities located in the United States provided that:
- OP can independently authenticate that the verification is received directly from the licensing authority.
- The applicant had no opportunity to directly access or alter the verification before it is sent or transmitted.
- Any licensing authority verification submissions should be made electronically to DPLSVerif@nysed.gov.*