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Form 5 - Application for a Limited (Intern) Permit

You must obtain an intern permit before engaging in the supervised practice of pharmacy in New York. Answer all questions on Form 5 and send it with your fee of $70 to the New York State Education Department. Be sure to sign item 10 and have your signature notarized by a notary public.

  • If you are a student in an accredited pharmacy program, the school must certify that you have completed at least the third year of a five- or six-year curriculum by completing the back of the Form 5.
  • If you are a graduate from a non-accredited program, do not submit Form 5 until after you have passed NAPLEX (Part I).