Form 4A - Verification of Experience

One of these forms must be completed and submitted by each employer or client who can attest to the professional experience for which you are seeking credit. The Office of the Professions will not accept this form if submitted by the applicant.

• Section I: Complete this section and forward this form to the appropriate employer or client.
• Section II: The employer or client must complete this section and return the form directly to the Office of the Professions at the mailing address at the end of the form.

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.