License Application Forms for Dietetics and Nutrition

All applicants for licensure must initially submit Form 1 along with the $294 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.
 

This form must be submitted directly by the educational institution you attended.

• Section I: Complete this section of the form before sending it to your school. Be sure to sign and date item 9 and include any required fee.
• Section II: The Registrar or appropriate school official must complete this section and return the form in a school envelope directly to the Office of the Professions at the mailing address at the end of the form.

If your program was not registered by the New York State Education Department as qualifying for certification or was not accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) at the time you completed the program, the Registrar must complete Part B. Remind the school that they must attach an official transcript or marksheet showing courses you completed each year and your grades.

NOTE: programs that were "approved" by ACEND must also forward an official transcript and have the Registrar complete Part B.

When studies were completed at more than one school, official records need to be sent to the Office of Professions from each college. Please photocopy the form as needed.

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.

This form must be submitted directly by the Certification Board for Nutrition Specialists (CBNS) or the Commission on Dietetic Registration (CDR).

• Section I: Complete this section of the form before sending it to the CBNS or the CDR.
• Section II: The CBNS or the CDR must complete this section and submit the form directly to:

The New York State Education Department, Office of the Professions
Dietetics and Nutrition Unit
89 Washington Avenue
Albany, NY 12234-1000.

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.

Applicants with associates degrees must complete and submit this form with the application for certification (Form 1) directly to the Office of the Professions at the mailing address at the end of Form 1. List all of your work experience in dietetics or nutrition. If the work experience is planned work experience, indicate that in item 5.

Applicants with associate degrees must complete Section I of this form and forward it to the appropriate supervisor for completion of Section II. Your supervisor must complete Section II and submit this form directly to the Office of the Professions at the mailing address at the end of the form. You may photocopy this form as needed to report the total amount of experience required. A Form 4B is not required for the "planned work experience" for which you submit a Form 4C.

This form must be submitted directly by the supervisor or internship coordinator.

Complete Section I and forward it to the dietitian or nutritionist who supervised your "planned work experience." Ask your supervisor to complete Section II and submit it directly to the Office of the Professions at the mailing address at the end of Form 4C.

Form 4C should be completed by the internship coordinator at the school if your experience was completed in an internship program.

Applicants with associate degrees must complete Section I and forward a separate Form 4E to each of the three acceptable dietitians or nutritionists who are endorsing them for certification. Each endorser must complete Section II and submit the form directly to the Office of the Professions at the mailing address at the end of Form 4E.

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*.

*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.