This form must be submitted directly by at least two licensed professional colleagues.
- Section I: Complete this section and forward this form to at least two licensed professional colleagues to complete section II.
- Section II: Ask your professional colleagues to complete Section II and submit the completed form directly to the Office of the Professions at the address at the end of the form.
NOTE: A separate Form 4 must be received from each licensed colleague verifying your professional experience.
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*.