- Online Form 1 - Application for Dental Hygiene Local Infiltration Anesthesia/Nitrous Oxide Analgesia Certification
Important Notice: 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. If your registration has lapsed and you need to reregister, do not submit a Form 1. Instead, contact our customer services unit to request a Delayed Registration Application by e-mailing: firstname.lastname@example.org, or by calling 518-474-3817 Ext. 570. When e-mailing, be sure to include your profession, license number, address on record, new address (if changed), date of birth and the last 4 digits of your SSN.
All applicants for certification must submit this form along with the $25 certification 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.
- Form 2 - Verification of Education (28 KB)
- Section I: Complete this section of the form before sending it to the institution. Be sure to include any fee required by the institution and sign and date item 8.
- Section II: The Registrar or other appropriate official must complete this section and return the form in a sealed school envelope directly to the Office of the Professions at the address at the end of the form.