If you are or have been licensed as a physical therapist or physical therapist assistant in another state or U.S. territory, you must also submit Form 3 to verify your license. A separate Form 3 must be sent directly from each jurisdiction in which you currently or previously held a license.
- Section I: Complete this section of the form before sending it to the licensing authority. Make sure to include any fee required by that licensing authority for the certification or verification of a license. Be sure to sign and date item 7.
- Section II: The state or U.S. territory in which you have previously applied for a license or been issued a license must complete this section and forward it directly to The Office of the Professions. The licensing authority must apply an original signature and stamp or seal and return the form directly to:
The NYS Education Department
Office of the Professions
Division of Professional Licensing Services
Physical Therapy Unit
89 Washington Avenue
Albany, NY 12234-1000.
Note: 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. jurisdictions 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.