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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*

*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.