This form must be submitted directly by the state licensing authority.
Use this form ONLY if you are licensed in another state and have not attempted the CCT examination. Applicants who have passed the NBE and CCT or have passed NAVLE and whose education has been approved by New York State are not required to file Form 3 or 4.
- Section I: Complete this section of the form before sending it to the state licensing authority. Be sure to include any fee required by the other 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.
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 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.