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This form must be submitted directly by at least two licensed professional colleagues.

  • Section I: Complete this section and forward this form to at least two licensed professional colleagues to complete section II.
  • Section II: Ask your professional colleagues 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.

NOTE: A separate Form 4 must be received from each licensed colleague verifying your professional experience.

Electronic Verification of Experience

The Office of the Professions (OP) will accept experience forms directly from supervisors provided that:

  • OP can independently verify that the documentation is received directly from the supervisor
  • The applicant had no opportunity to directly alter the experience form before it is sent or transmitted.
  • Any experience documentation submissions should be made electronically to*.
*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.