License Application Forms: Nurse Practitioner

All applicants for licensure must initially submit Form 1 along with the $85 certification and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated. Failure to accurately complete all required parts of the application will delay its review. Additional forms below are required based on the licensure requirements of the profession. Do not use Form 1 to renew your existing license.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

For applicants who have graduated from a nurse practitioner education program registered by the State Education Department or a program determined by the Department to be equivalent.

This form must be submitted directly to the Office of the Professions by the professional school you attended. This form will not be accepted if submitted by the applicant or any party other than the school official.

• Section I: Complete this section of the form before sending the entire form to your school. Be sure to sign and date item 11.
• Section II: The Registrar must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

Electronic Education Documentation
The Office of the Professions (OP) will accept official electronic transcripts and forms from educational institutions (i.e. colleges/universities) or designated third-party* transcript entities located in the United States or Canada provided that:

• The transcript is the certified true and official academic record and the document does NOT have an expiration date**.
• OP can independently verify that the documentation is received directly from the educational institution’s registrar or officially designated third-party.
• If a third-party transcript provider is involved, it is clear that the educational institution has designated the third party as the official sole provider of its transcripts.
• The applicant had no opportunity to directly access or alter the transcript before it is sent or transmitted.
• Any educational institution education documentation submissions should be made electronically to DPLSEduc@nysed.gov***.

*OP will only accept third-party submissions after we have determined that the arrangement between the educational institution and the third party is consistent with our security and verification standards.

**Transcript documents with expiration dates cannot be accepted. Expirations on links to the document are acceptable.

***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.

Required Coursework on Laws Governing Prescriptions and Record Keeping

If you graduated from an in-state New York State Education Department (NYSED) registered NP education program, you completed this coursework as part of your studies.

If you did not graduate from an in-state NYSED registered NP program, you must complete coursework on New York and Federal Laws Governing Prescriptions and Record Keeping. The following organizations offer this coursework online:

The Nurse Practitioner Association of New York State
Phone 518-348-0719
Web www.thenpa.org

The New York State Nurses Association
Phone 518-782-9400 Ext. 377
Web www.elearnonline.net

This form must be submitted directly to the Office of the Professions by the school, institution or professional association where you completed instruction. This form will not be accepted if submitted by the applicant or any party other than the school, institution or professional association official.

• Section I: Complete this section of the form before sending the entire form to the school, institution or professional association where you completed instruction in New York State and federal laws relating to prescriptions and record keeping. Be sure to sign and date item 8.
• Section II: The Registrar must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

For applicants who have completed a program other than a program registered by the New York State Education Department as qualifying for a certificate.

This form must be submitted directly to the Office of the Professions by the school, institution or professional association where you completed instruction. This form will not be accepted if submitted by the applicant or any party other than the school, institution or professional association official.

• Section I: Complete this section before sending the entire form to the school institution or professional association where you completed a pharmacotherapeutic course, including instruction in drug management of clients in the nurse practitioner's specialty area. Be sure to sign and date item 8.
• Section II: The Registrar must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

For applicants seeking a New York State nurse practitioner certificate through a national certifying organization.

This form must be submitted directly to the Office of the Professions from the national certifying organization that will verify your certification examination. The Office of the Professions will not accept this form if submitted by the applicant or any other party.
 

• Section I: Complete this section before sending the entire form to the national certifying organization to verify that you passed the nurse practitioner certification examination. Be sure to sign and date item 9.
• Section II: The national certifying organization must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

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. jurisdiction 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 or Canada 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.*

*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.

Note: Nurse practitioners (NPs) with more than 3,600 hours of experience as an NP licensed in any state or working for US Armed Forces, US Veterans Administration or the Public Health Service can choose to practice and have collaborative relationships instead of practicing in pursuant to a written practice agreement with a collaborating physician. Newly certified NPs (with more than 3,600 hours of qualifying NP experience) who choose to practice and have collaborative relationships as allowed by New York Law SHOULD NOT fill out Form 4NP.

All other newly certified NPs must fill out and submit Form 4NP to the Office of the Professions NO LATER than 90 days after the commencement of practice. This submission to the Office of the Professions is only required once.

• Section I: Complete this section of the form.
• Sections II & III: You and the initial collaborating physician with whom you have a practice agreement and practice protocol must complete these sections and return both pages of the form to the Office of the Professions at the address at the end of the form. Be sure to sign item 4 in Section III.