License Application Forms for Midwifery

All applicants for licensure must initially submit Form 1 along with the $322 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.

This form must be submitted directly by the professional school you attended.

• Section I: Complete this section of the form before sending it to the professional school(s) verifying your professional education. Be sure to sign and date item 8. Send this form to the school(s) you attended and ask them to complete the appropriate section of the form. Be sure to include any fee required by the school. A separate Certification of Professional Education must be submitted for each educational program attended.
• Section II: The Registrar must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.

Note: If you graduated after December, 1995, completed the pharmacology and law courses at the same institution where you completed your New York State registered, licensure qualifying midwifery program, AND that institution is located in New York State, you do NOT have to complete either Form 2A or Form 2B. If the institution is located outside of New York State, you must still complete a Form 2B.

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 institution providing the pharmacology course.

• Section I: Complete this section of the form. Be sure to sign and date item 7 and send it to the institution that provided the pharmacology course. Ask the institution to verify your attendance at the three-hour pharmacology course (or equivalent) by completing the appropriate section of the form. Be sure to include any fee required.
• Section II: The Registrar must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.

This form must be submitted directly by the institution/organization providing the instruction in New York State and federal laws relating to prescriptions and record keeping.

• Section I: Complete this section of the form. Be sure to sign and date item 7 and send it to the institution/organization that provided the instruction in New York State and federal laws relating to prescriptions and record keeping. Ask the institution/organization to verify your completion on the appropriate section of the form. Be sure to include any fee required.
• Section II: The Registrar or appropriate institution/organization official must complete this section and return the form directly to the Office of the Professions at the address at the end of the form.

You may apply for a limited permit by submitting the Application for Limited Permit (Form 5) and limited permit fee of $70 at the same time or any time after you submit your application for licensure (Form 1), licensure fee of $322, and evidence of satisfactory education. The limited permit is valid for a period of one year and may not be renewed. The State Education Department must approve your education before your application for a limited permit can be approved.

• Section I: Complete this section and be sure to sign and date item 10.
• Section II: Ask your prospective employer to complete this section.