If you have held a New York State Limited License for Clinical Laboratory Technology or Certified Histological Technician DO NOT USE THIS FORM. Use Form 5PP ONLY.
This form must be submitted directly by the educational institution(s) you attended. The Office of the Professions will not accept this form if submitted by the applicant.
- Section I: Complete this section before sending the entire form to your school. Be sure to sign and date item 9.
- Section II: The Registrar must complete this section and return both pages of the form in a school envelope with requested documents directly to the Office of the Professions at the address at the end of 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 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.