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License Application Forms for Certified Behavior Analyst Assistants

Important Notice: DO NOT use Form 1 if you are already licensed in this profession in New York State. 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. To renew your registration online, visit http://op.nysed.gov/services/online-registration-renewal. If your registration has lapsed for longer than 4 months, submit a Delayed Registration Application.

All applicants for certification must initially submit Form 1 along with the appropriate fee ($225 for certified behavior analyst assistants) for licensure/certification and first registration. 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.

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All applicants for licensure must initially submit Form 1. 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. No fee is required with this form.

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.

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Complete this form if you would like your education to be reviewed under the standard licensing provisions (Pathway Two). The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section of the form before sending it to the institution(s) where you completed your professional education. If you completed a program that was not registered by the New York State Education Department as licensure-qualifying at the time the degree requirements were met, be sure to request that institution to provide an official transcript or official marksheets, as well as course descriptions and/or syllabi for all courses, if available.
  • Section II: The Registrar must complete this section and return the form along with any other required documentation directly to the Office of the Professions at the mailing address at the end of the form.

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, Canada, and the Philippines 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.

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Complete this form if you hold, or ever held, a license or certificate to practice any profession* in any jurisdiction. Note: DO NOT use this form to verify certification in Applied Behavior Analysis by a national certifying body.

This form must be submitted directly by the licensing/certifying authority. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section before sending the entire form to the appropriate licensing/certifying authority. Be sure to sign and date item 7. A separate Form 3 must be submitted for all licenses/certificates you have ever held except those issued by the New York State Education Department.
  • Section II: The licensing/certifying authority must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

NOTE: A Form 3 is not required for licenses/certificates issued by the New York State Education Department. Also, If the certification/verification documentation provided by a U.S. jurisdictions contains the same information requested in the Form 3, completion of a Form 3 for that jurisdiction is not necessary. For certification/verification documentation that does not contain the same information, a Form 3 will need to be completed for that jurisdiction.

*Profession is defined as professional titles licensed under New York State Education Law. 

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.

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ONLY use this form to verify certification by the Behavior Analyst Certification Board.

This form must be submitted directly by the Behavior Analyst Certification Board. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section before sending the entire form to the Behavior Analyst Certification Board. Be sure to sign and date item 8. 
  • Section II: The Behavior Analyst Certification Board must complete this section, sign, date and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

 

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This form must be submitted directly by the qualified professional who provided supervision of the professional experience claimed by the applicant. Please see General Information for Completing Report of Professional Experience (HTML | PDF) for further information. This form will not be accepted if submitted by the applicant.

  • Section I: Complete Section I in ink. In item 3, enter your name exactly as it appears on Your Application for Certification (Form 1). Be sure to sign and date item 7.
  • Section II: Make a copy for your records and forward this original form along with a copy of the Form 4Inf to your supervisor to complete Section II. The supervisor must send the form directly to the Office of the Professions at the address at the end of the form.
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All applicants for a limited permit must initially submit Form 5 along with the $70 limited permit fee. You must also submit a Form 5CS - Certification of Supervisor for Limited Permit along with your application.

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 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.

Changes to Supervisors and/or Settings
If you change supervisors and/or settings, or you have to add or remove a supervisor or setting, after a permit is issued, you must obtain an amended permit using the Limited Permit Change Form. After changes are processed you will receive an amended permit. A fee is not required for an amended permit issued as a result of a change in supervisor or setting. You must also submit a Form 5CS - Certification of Supervisor for Limited Permit for each new supervisor you are adding (see Upload Additional Documentation above).

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Use this form ONLY if you are applying/have applied for a New York State Limited Permit as a Licensed Behavior Analyst or Certified Behavior Analyst Assistant online.

  • Section I: Complete this section.
  • Section II: Your supervisor must complete this section before you can submit it to the Office of the Professions at the appropriate address at the end of the form. It is your responsibility to ensure your supervisor fully completes Section II. Failure to complete this form will delay its review.
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Program graduates seeking to complete supervised experience and/or examination requirements for certification or registration  by a national  certifying body having certification or registration standards acceptable to the commissioner must submit this form with the $10 non refundable fee. You must also submit a Licensed Behavior Analysis Supervisor Attestation for Program Graduates Form to complete the application.

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 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.

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Use this form ONLY if you are applying/have applied for a New York State Graduate Permit as a Licensed Behavior Analyst or Certified Behavior Analyst Assistant

  • Section I - Complete Section I. 
  • Section II - Have your supervisor complete Section II and return all pages of this form to the Office of the Professions at the appropriate address at the end of the form.
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