The New York State Education Department (“SED”) Office of the Professions (“OP”) is alerting everyone to a vishing scam that has been brought to our attention. Phishing—or “vishing”—scams impersonate SED employees or websites attempting to collect licensure and personal information from the licensee. If you receive an inquiry which you believe to be suspicious do not provide any information. To verify if the inquiry was from OP, contact us directly. You may report any suspicious communication received to the Federal Trade Commission.
  • NYSED Homepage
  • Disclaimer
  • Contact Us
  • NYSED Employment
  • Board Members Only

Form 4A - Supporting Affidavit of Professional Practice for Endorsement Applicants

ONLY use this form if you are applying for licensure in New York State by endorsement, have completed the NBEO Examination Parts I and II, and HAVE NOT COMPLETED either the NBEO Part III or NERCOATS examination.

  • Complete Section I. Be sure to sign and date item 8.
  • Send the entire form to a licensed optometrist or ophthalmologist who will endorse your professional practice and ask that they complete Section II and submit the completed form to the Office of the Professions at the address at the end of the form. This form will not be accepted if submitted by the applicant.

Important Note: You must present evidence of at least 5 years of professional practice of optometry following initial licensure and within 10 years of applying for licensure endorsed by other licensed optometrists and/or ophthalmologists using Form 4A.

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.