You may print and keep this checklist as a reminder of what forms you have filed and when you filed them. 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.
Online Form 1 - Application for a Clinical Nurse Specialist Certificate
All applicants for licensure must initially submit Form 1 along with the $80 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
For applicants who have completed a program registered by the State Education Department as qualifying for a certificate or a program determined by the Department to be equivalent.
This form must be submitted directly to the Office of the Professions by the professional school you attended. This form will not be accepted if submitted by the applicant or any party other than the school official.
- Section I: Complete this section of the form before sending the entire form to your school. Be sure to sign and date item 11.
- Section II: The Registrar 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.
Form 3 - Verification of Other Professional Licensure/Certification
Complete this form if you hold, or have ever held, a license or certificate to practice as a clinical nurse specialist in any jurisdiction.
This form must be submitted directly by the licensing/certifying authority. 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 the licensing/certifying authority of each jurisdiction in which you are or have been licensed/certified. Be sure to sign and date item 9.
- Section II: The licensing/certifying authority must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.
Form 3C - Verification of Clinical Nurse Specialist Certification
For applicants seeking a New York State clinical nurse specialist certificate through a national certifying organization.
This form must be submitted directly to the Office of the Professions from the national certifying organization that will verify your certification. The Office of the Professions will not accept this form if submitted by the applicant or any other party.
- Section I: Complete this section before sending the entire form to the national certifying organization to verify that you are certified. Be sure to sign and date item 9.
- Section II: The national certifying organization 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.
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.
Last Updated: March 26, 2020