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Form 4A - Verification of Professional Experience

Instructions For Completing Report of Professional Experience and Verification of Professional Experience 4 and 4A | PDF (19 KB). See these instructions for additional information to document your geology experience.

Please note: Section II of Form 4A must be typed or printed legibly, if typed, be sure to use a font size of 10 or greater as smaller fonts create difficulty for reviewers and will slow the review of your application. Also, a completed Form 4A must be submitted directly to the Office of the Professions by the endorser. This form will not be accepted if submitted by the applicant.

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 DPLSExperience@nysed.gov*.

*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.