Online Form 1 - Application for Licensure for Audiologists
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.
Form 2 - Certification of Professional Education
If you received your graduate degree before April 1, 1976, do not use this form. Have your school(s) send undergraduate and graduate transcripts to the Office of the Professions. Verification from school(s) must also include practicum information.
This form must be submitted directly by the educational institution. 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 your school. Be sure to sign and date item 9.
- Section II: The registrar or appropriate school official must complete this section, sign and date and return the form in an official school envelope directly to the Office of the Professions at the address at the end of the form.
Form 3 - Verification of Other Professional Licensure/Certification
Complete this form if you hold, or ever held, a license or certificate to practice any profession* in any jurisdiction.
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 licensing/certifying authority of each jurisdiction in which you are or have been licensed/certified. Be sure to sign and date item 8.
- 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.
Please photocopy this form as needed.
*Profession is defined as professional titles licensed under New York State Education Law.
Form 4A - Identification of Supervisor and Setting
This form should be submitted at the beginning of your supervised experience. When the Application for Licensure (Form 1), the fee, Certification of Professional Education Form (Form 2), and Identification of Supervisor and Setting Form are received and approved, you will receive verification (Form 6).
If application is not made until after the supervised experience begins, or at the end of the experience, it is still necessary to complete and submit this form.
- Section I: Complete this section and ask your employer and/or supervisor to complete Section II, Part A.
- Section II: Complete parts B, C and D of this section with your employer and/or supervisor and then return the entire form directly to the Office of the Professions at the address at the end of the form.
Form 4B - Record of Supervised Experience
Your supervisor must send this form directly to the Office of the Professions at the end of the supervised experience. The Office of the Professions will not accept this form if it is submitted by the applicant.
- Section I: Complete this section before sending the entire form to your supervisor. Be sure to sign and date item 7 once the work experience is complete.
- Section II: Your supervisor must review this section and complete the attestation then return both pages of the form directly to the Office of the Professions at the address at the end of the form.
If you completed your experience in the past and are certified by the American Speech-Language Hearing Association (ASHA), you may send a copy of the Clinical Fellowship Year (CFY) Plan and Report for consideration directly to the Office of the Professions at:
New York State Education Department
Office of the Professions
Division of Professional Licensing Services
Speech-Language Pathology and Audiology Unit
89 Washington Avenue
Albany, NY 12234-1000
Phone: 518-474-3817 ext. 270
Fax: 518-402-5354
E-mail: opunit3@nysed.gov
However, Forms 4A and 4B are preferred, especially if the experience requirement was completed in New York State within the last five years. You may contact ASHA at:
ASHA
2200 Research Blvd.
Rockville, MD 20850-3289
Phone: 800-498-2071
E-mail: actioncenter@asha.org
Web: www.asha.org
Form 4E - Affidavit of Professional Practice for Endorsement Applicants
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This form must be submitted directly by the licensed speech-language pathologist or audiologist who will endorse your license application. The Office of the Professions will not accept this form if submitted by the applicant. This form is to be used only by individuals already licensed as a Speech-Language Pathologist or Audiologist in another state or jurisdiction.
- Section I - Complete this section and forward this form to the licensed speech-language pathologist or audiologist who will endorse your licensure application (the endorser must be licensed in the jurisdiction where you were employed). Be sure to sign and date item 7.
- Section II - The endorser must complete this section and return the entire form to the Office of the Professions at the address at the end of the form.