License Application Forms for Physicians

You may print and keep this checklist as a reminder of what forms you need to file. 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.

All applicants for licensure must initially submit Form 1 along with the $735 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.

PLEASE NOTE: If you are not using FCVS, you must have your educational institution send this form directly to the Office of the Professions. We will not accept this form if it is submitted by the applicant or a third party.

Graduates of programs not registered as licensure qualifying by New York State or accredited by the Liaison Committee on Medical Education (LCME), or the American Osteopathic Association (AOA) - do not use this form. You must use FCVS to collect your credentials.

• Section I: Complete this section of the form before sending it to your professional school. If you graduated from a medical school that was not registered by New York State or accredited by LCME/AOA, notify the school that a transcript must accompany the form. If you attended a medical school that has been closed, send this form to the official repository of the records for that school; e.g., CONES.
• Section II: The Registrar, Dean, Rector, or Principal of the medical school must complete the appropriate parts of this section and return the form directly to the Office of the Professions in an official school envelope at the address on the form.

Please make as many copies of Form 2 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.

Use this form only if you are a graduate of a non-LCME-accredited medical school located in one country but completed one or more clinical clerkships in another country.

Please Note: This form must be mailed directly to the Office of the Professions by the hospital in its identifying envelope. We will not accept this form if it is submitted by the applicant or a third party.

The New York State Education Department has approved specific schools to allow students to complete more than 12 weeks of clinical clerkships in New York State. A list of these schools can be found here. Form 2CC is not needed for those graduates who completed all clerkships after the approval date listed. Note: Form 2CC is required for any clerkships completed prior to that approval date.

Former students of CIFAS, CETEC, and UTESA should not use Form 2CC. These applicants should request special clerkship verification forms from the Office of the Professions, Bureau of Comparative Education at (518) 474-3817 ext. 300 or by e-mail at comped@nysed.gov.

• Section I: Complete this section of the form before sending it to the hospital where you completed your clinical clerkship.
• Section II: The Director of Medical Education or Department Chair must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 2CC as needed.

Use this form only if you are not using FCVS.

Please Note: This form must be mailed directly to the Office of the Professions by the hospital in its identifying envelope. Documentation of postgraduate training can only be accepted if signed less than one month prior to the completion date of the training period for which credit is sought. If you or a third party send this form, we will take no further action until we receive direct verification from the hospital.

• Section I: Complete this section of the form before sending it to the hospital where you completed your postgraduate training.
• Section II: The Director of Medical Education or Department Chair must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 2PGT as needed.

*Approved by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the Royal College of Physicians and Surgeons of Canada.

Use this form only if you were licensed and practiced medicine in another country within the 5-year period immediately prior to the date of your application for licensure or a limited permit in New York State.

Please Note: This form must be sent to the Office of the Professions by the licensing jurisdiction. We will not accept this form if it is submitted by the applicant or a third party.

• Section I: Complete this section of the form before sending it to the licensing authority of each country in which you were licensed to practice medicine within the 5-year period immediately prior to the date of your application for licensure in New York State.
• Section II: The appropriate official of the licensing authority must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 3A as needed.

Use this form only if you are requesting endorsement of a medical license based on a pre-1972 state licensing examination.

Please Note: This form must be sent to the Office of the Professions by the licensing jurisdiction. We will not accept this form if it is submitted by the applicant or a third party.

• Section I: Complete this section of the form before sending it to the state licensing authority where you took your pre-1972 state licensing examination.
• Section II: The appropriate official of the licensing authority must fully complete this section and return the form directly to the Office of the Professions at the address on 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.

Use this form only if you are requesting licensure based on endorsement of another license.

Please Note: This form must be sent to the Office of the Professions by the licensed physician verifying your practice. We will not accept this form if it is submitted by the applicant.

• Section I: Complete this section of the form before sending it to the licensed physician verifying your professional practice of medicine. More than one form may be necessary to verify the total number of years of professional practice required for endorsement.
• Section II: The licensed physician must complete this section and return the form directly to the Office of the Professions at the address on the form.

Please make as many copies of Form 4 as needed.

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.

This application form is only for applicants requesting a limited permit who also seek licensure in New York State.

You must have already submitted your application and fee for licensure and arranged to have the other required documentation sent to us. You need only submit Form 5A and the appropriate limited permit fee.

• Section I and II: Complete all parts of these sections before forwarding it to your prospective employer.
• Section III: Your prospective employer completes Section III. Either you or your employer must send the completed form and fee to the Office of the Professions at the address listed on the form.

Please Note: If you did not complete the required coursework or training in the identification and reporting of child abuse as part of your educational program, you must submit either a Certificate of Completion from an approved provider or a Certificate of Exemption Form.

This application is only for applicants requesting a limited permit who do not seek licensure in New York State.

In addition to Form 5B, you must submit the appropriate limited permit fee and arrange to have the other required documentation sent to us.

• Section I and II: Complete all parts of these sections before forwarding it to your prospective employer.
• Section III: Your prospective employer completes Section III. Either you or your employer must send the completed form and fee to the Office of the Professions at the address listed on the form.

Please Note: If you did not complete the required coursework or training in the identification and reporting of child abuse as part of your educational program, you must submit either a Certificate of Completion from an approved provider or a Certificate of Exemption Form.