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 school, institution or professional association 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.
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