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Form 4B - Verification of Experience

This is only required for applicants licensed in another state, territory or country who are seeking licensure by endorsement in New York State.

This form must be submitted directly from the individual verifying the applicant's professional work experience.

  • Section I: Complete this section in ink. Be sure to sign and date the attestation. Send the form to the employer, co-worker or colleagues who will verify your work experience.
  • Section II: Have your employer, co-worker, or colleagues who will attest to your experience complete Section II, sign, date and send the form directly to the Office of the Professions at the 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.