License Application Forms for Physicians

You may print and keep this checklist as a reminder of what forms you need to file. This is for your reference and should not be submitted with your application forms. You should also keep a copy of all application forms submitted.

All applicants for licensure must initially submit Form 1 along with the $735 licensure and first registration fee. You must answer all questions and provide all information requested unless otherwise indicated. Failure to accurately complete all required parts of the application will delay its review. Additional forms below are required based on the licensure requirements of the profession. Do not use Form 1 to renew your existing license.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID, Social Security Number, and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

PLEASE NOTE: If you are not using FCVS, you must have your educational institution send this form directly to the Office of the Professions. We will not accept this form if it is submitted by the applicant or a third party.

Graduates of programs not registered as licensure qualifying by New York State or accredited by the Liaison Committee on Medical Education (LCME), or the American Osteopathic Association (AOA), or the Committee on the Accreditation of Canadian Medical Schools (CACMS) - do not use this form. You must use FCVS to collect your credentials.

• Section I: Complete this section of the form before sending it to your professional school. If you graduated from a medical school that was not registered by New York State or accredited by LCME/AOA/CACMS, notify the school that a transcript must accompany the form. If you attended a medical school that has been closed, send this form to the official repository of the records for that school; e.g., CONES.
• Section II: The Registrar, Dean, Rector, or Principal of the medical school must complete the appropriate parts of this section and return the form directly to the Office of the Professions in an official school envelope at the address on the form.

Please make as many copies of Form 2 as needed.

ONLY USE THIS FORM if you have completed one or more clinical clerkships in a country other than where your medical school is located. 

DO NOT USE THIS FORM for clerkships completed for CETEC, CIFAS, and UTESA. You can contact the Bureau of Comparative Education by email at comped@nysed.gov to request a form to complete for these clerkships.

• Section I: Complete this section of the form before sending it to the medical school you attended and ask the clerkship director to complete Section II.
• Section II: The Clerkship Director must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 2CC-A as needed.

ONLY USE THIS FORM if you have completed one or more clinical clerkships in a country other than where your medical school is located. 

DO NOT USE THIS FORM for clerkships completed for CETEC, CIFAS, and UTESA. You can contact the Bureau of Comparative Education by email at comped@nysed.gov to request a form to complete for these clerkships. 

DO NOT USE THIS FORM if you can verify that the following criteria have been met: a) you are fully certified by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA): you hold an unrestricted current license in another state; and c) you have satisfactorily completed at least three (3) years of ACGME, AOA, or RCPSC accredited residency training. If these criteria are met, you only need to complete Form 2CC-A

Section I: Complete this section of the form before sending it to the hospital where you completed your clinical clerkship.
Section II: The Director of Medical Education or Department Chair must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 2CC-B as needed.

Use this form only if you are not using FCVS.

Please Note: This form must be mailed directly to the Office of the Professions by the hospital in its identifying envelope. Documentation of postgraduate training can only be accepted if signed less than one month prior to the completion date of the training period for which credit is sought. If you or a third party send this form, we will take no further action until we receive direct verification from the hospital.

• Section I: Complete this section of the form before sending it to the hospital where you completed your postgraduate training.
• Section II: The Director of Medical Education or Department Chair must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 2PGT as needed.

*Approved by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the Royal College of Physicians and Surgeons of Canada.

Use this form only if you were licensed and practiced medicine in another country within the 5-year period immediately prior to the date of your application for licensure or a limited permit in New York State.

Please Note: This form must be sent to the Office of the Professions by the licensing jurisdiction. We will not accept this form if it is submitted by the applicant or a third party.

• Section I: Complete this section of the form before sending it to the licensing authority of each country in which you were licensed to practice medicine within the 5-year period immediately prior to the date of your application for licensure in New York State.
• Section II: The appropriate official of the licensing authority must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 3A as needed.

Use this form only if you are requesting endorsement of a medical license based on a pre-1972 state licensing examination.

Please Note: This form must be sent to the Office of the Professions by the licensing jurisdiction. We will not accept this form if it is submitted by the applicant or a third party.

• Section I: Complete this section of the form before sending it to the state licensing authority where you took your pre-1972 state licensing examination.
• Section II: The appropriate official of the licensing authority must fully complete this section and return the form directly to the Office of the Professions at the address on the form.

Use this form only if you are requesting licensure based on endorsement of another license.

Please Note: This form must be sent to the Office of the Professions by the licensed physician verifying your practice. We will not accept this form if it is submitted by the applicant.

• Section I: Complete this section of the form before sending it to the licensed physician verifying your professional practice of medicine. More than one form may be necessary to verify the total number of years of professional practice required for endorsement.
• Section II: The licensed physician must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 4 as needed.

All applicants for a limited permit who also seek licensure in New York State must initially submit Form 5A along with the $105 limited permit fee. You must also submit a Form 5CS - Certification of Supervision for Limited Permit along with your application.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

Changes to Employment or Practice Status
If there is a change of employment or practice status, you must obtain an amended permit using the Limited Permit Change Form and submit a Form 5CS. After changes are processed you will receive an amended permit. An additional fee is not required (see Upload Additional Documentation above). Note: A permit authorizing practice in one facility MAY NOT be used in another facility without prior approval by the Department.

All applicants for a limited permit who ARE NOT seeking licensure in New York State must initially submit Form 5B along with the $105 limited permit fee. You must also submit a Form 5CS - Certification of Supervision for Limited Permit along with your application.

Continuing Your Application
If you have started an application within the past 30 days, and have not yet completed it, you can use this link to continue your application. You will need your Application ID and Date of Birth.

Upload Additional Documentation
If you have already completed an application, but you have additional documents or files to include in your previous submission, use this link to upload additional documentation. You will need your Application ID and Date of Birth.

Changes to Employment or Practice Status
If there is a change of employment or practice status, you must obtain an amended permit using the Limited Permit Change Form and submit a Form 5CS. After changes are processed you will receive an amended permit. An additional fee is not required (see Upload Additional Documentation above). Note: A permit authorizing practice in one facility MAY NOT be used in another facility without prior approval by the Department.

Use this form ONLY if you are applying/have applied for a New York State Limited Permit as a Physician. 

•    Section I: Complete this section.
•    Section II: Your employer must complete this section before you can submit it to the Office of the Professions at the appropriate address at the end of the form. It is your responsibility to ensure your employer fully completes Section II. Failure to complete this form will delay its review.