License application or licensure application

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 OP directly using the following contact information. You may report any suspicious communication received to the Federal Trade Commission.

Psychology

Laws, Rules & Regulations License Requirements Application Forms Professional Practice Continuing Education Questions and Answers Approval under Section 72.6(i) Providers Q&A About Licensure and Limited Permits Consumer Information Contact Information License Statistics Use and Supervision of a Testing Technician Board Meetings

Important Notice: DO NOT use Form 1 if you are already licensed in this profession in New York State. A New York State professional license is valid for life unless it is revoked, annulled, or suspended by the Board of Regents. To practice in New York State, your professional license must be registered. To renew your registration online, visit http://op.nysed.gov/services/online-registration-renewal. If your registration has lapsed for longer than 4 months, submit a Delayed Registration Application.

Online Form 1 - Application for Licensure

All applicants for licensure must initially submit Form 1 along with the $294 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.

Change Address or Name You are required to notify us within 30 days of any address or name changes. Please read the instructions to request this change.

Form 2 - Certification of Professional Education

This form must be submitted directly from the professional school.

• Section I: Complete this section of the form before sending it to your educational institution. Be sure to sign and date item 10.
• Section II: The Registrar must complete this section and return the form with an official transcript in a sealed school envelope directly to the Office of the Professions at the mailing address on the form.

Electronic Education Documentation

The Office of the Professions (OP) will accept official electronic transcripts and forms from educational institutions (i.e. colleges/universities) or designated third-party* transcript entities located in the United States, Canada, Brazil and the Philippines provided that:

• The transcript is the certified true and official academic record and the document does NOT have an expiration date**.
• OP can independently verify that the documentation is received directly from the educational institution’s registrar or officially designated third-party.
• If a third-party transcript provider is involved, it is clear that the educational institution has designated the third party as the official sole provider of its transcripts.
• The applicant had no opportunity to directly access or alter the transcript before it is sent or transmitted.
• Any educational institution education documentation submissions should be made electronically to DPLSEduc@nysed.gov***.

*OP will only accept third-party submissions after we have determined that the arrangement between the educational institution and the third party is consistent with our security and verification standards.

**Transcript documents with expiration dates cannot be accepted. Expirations on links to the document are acceptable.

***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.

Form 3 - Certification of Out of State Licensure and Examination Grades

Use this form only if you are or have been licensed as a psychologist in another jurisdiction.

This form must be submitted directly by the licensing authority.

• Section I: Complete this section of the form before sending it to the licensing authority of each jurisdiction in which you are or have been licensed as a psychologist. Be sure to sign and date item 8.
• Section II: The licensing authority must complete this section, sign, date and return the form directly to the Office of the Professions at the mailing address on the form. A separate Form 3 must be submitted from each state where a license was granted.
  

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.

Electronic Verification of Licensure, Certification and/or Examination

The Office of the Professions (OP) will accept electronic verifications of licensure, certification and examination completion from other licensing authorities located in the United States provided that:

• OP can independently authenticate that the verification is received directly from the licensing authority.
• The applicant had no opportunity to directly access or alter the verification before it is sent or transmitted.
• Any licensing authority verification submissions should be made electronically to DPLSVerif@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.

Form 4 - Report of Professional Experience

This form must be submitted directly by the supervising psychologist who provided supervision of the professional experience claimed by the applicant. Please see instructions, also contained on the PDF form, for further information.

• Section I: Complete this section and send the form and Instructions for Completing the Report of Professional Experience (Form 4) to your supervising psychologist. Be sure to sign and date item 7.
• Section II and III: The supervising psychologist must complete these sections, sign and date the form and return it directly to the Office of the Professions at the mailing address on the form.

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.

Form 4F - Certification of Licensed Experience Experience

This form is for applicants seeking licensure in New York State by endorsement of a license to practice Psychology issued by another jurisdiction. You must have at least 5 years of licensed experience in Psychology in the 10 year period prior to applying for licensure in New York State.

This form must be submitted by the licensed colleague(s) who is attesting to your licensed practice as a Psychologist in another jurisdiction. The Office of the Professions will not accept this form if submitted by the applicant.

• Section I: Complete this section and send the entire form to the licensed colleague who will attest to your experience as a Psychologist in another jurisdiction. Be sure to sign and date item 9.
• Section II: The licensed colleague who will attest to your licensed experience must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form. A separate Form 4F must be submitted for each licensed colleague listed in Item 15 of the Application for Licensure by Endorsement (Form 1).

• 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*.

Online Form 5A - Application for Limited Permit For Persons Gaining Experience For Licensure

All applicants for a limited permit must initially submit Form 5 along with the $70 permit fee. You must also submit a Form 5CS - Certification of Supervisor 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 Supervisors and/or Settings
If you change supervisors and/or settings, or you have to add or remove a supervisor or setting, after a permit is issued, you must obtain an amended permit using the Limited Permit Change Form. After changes are processed you will receive an amended permit. A fee is not required for an amended permit issued as a result of a change in supervisor or setting. You must also submit a Form 5CS - Certification of Supervisor for Limited Permit for each new supervisor you are adding (see Upload Additional Documentation above)

Online Form 5B - Application for Limited Permit For Persons Licensed In Other Jurisdictions

All applicants for a limited permit must initially submit Form 5 along with the $70 permit fee.

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 Supervisors and/or Settings
If you change supervisors and/or settings, or you have to add or remove a supervisor or setting, after a permit is issued, you must obtain an amended permit using the Limited Permit Change Form. After changes are processed you will receive an amended permit. A fee is not required for an amended permit issued as a result of a change in supervisor or setting.

Form 5CS - Certification of Supervisor for Limited Permit

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

• Section I: Complete this section.
• Section II: Your supervisor 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 supervisor fully completes Section II. Failure to complete this form will delay its review.

Online Licensed Psychologist Attestation of Limited Practice in New York State

Qualifying out-of-state psychologists wishing to apply for temporary practice in New York State must submit this form with a $10 application fee. This is a one-time, temporary exemption to practice in New York State. Please note that practice under this one-time exemption (in person or through distance technology) shall not exceed 10 consecutive business days or a total of 15 business days in a 90-day period.

Should you need to provide services beyond the stated limitations, you will need to apply for full licensure. Instructions and applications for licensure may be found at https://www.op.nysed.gov/professions/psychology/license-application-forms. Note: an out-of-state licensed psychologist who resides in New York State and wishes to practice must apply for full licensure.

The practice of psychology by an out-of-state licensed psychologist is subject to the full disciplinary and regulatory authority of the Board of Regents and the Department pursuant to Title VIII of the Education Law.