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Form 4 - Certification of Trainee Experience in Ophthalmic Dispensing And/Or Contact Lens Dispensing

If you have completed a two-year training program in ophthalmic dispensing approved by the New York State Education Department or a one-year training program in contact lens dispensing approved by the Department, complete Section I of this form and submit it to the individuals(s) who supervised your trainee experience. They must then complete Section II and submit 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.

Additional Required Documentation

Applicants for ophthalmic dispensing licensure who have met the professional education requirement through an approved traineeship must also submit a certificate from the National Academy of Opticianry documenting completion of the Career Progression Program. In addition, the Department must have on file a high school transcript documenting completion of one year of mathematics such as algebra or geometry.

Applicants for certification in contact lens dispensing who have met the professional education requirement through an approved traineeship must also submit a certificate from the Contact Lens Society of America documenting completion of the Contact Lens Study Manual.

These certificates must be submitted directly by the issuing organization and will not be accepted if submitted by the applicant.