The New York State Education Department (“SED”) Office of the Professions (“OP”) is alerting everyone to a vishing scam that has been brought to our attention. Phishing—or “vishing”—scams impersonate SED employees or websites attempting to collect licensure and personal information from the licensee. If you receive an inquiry which you believe to be suspicious do not provide any information. To verify if the inquiry was from OP, contact OP directly using the following contact information. You may report suspicious calls or emails to the Federal Trade Commission.
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Application Forms for Licensed Clinical Social Worker

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.

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.

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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.

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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This form must be submitted directly by the educational institution(s) you attended. 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 your school. Be sure to sign and date item 9.
  • Section II: The Registrar must complete this section and return both pages of the form in an official school envelope with requested documents directly to the Office of the Professions at the address at the end of the form.

If you attended a social work program not registered as licensure qualifying by the New York State Education Department, you must also ask your school to submit an official transcript or marksheets.

Please photocopy this 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, 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.

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.

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

Important Information About 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 or Canada that meet certain criteria. More information can be found here.

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Send this document to the licensed professional(s) who supervised your experience or will supervise your practice under a limited permit along with the form you are asking them to complete.

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Complete and send both pages of this form directly to the Office of the Professions at the address at the end of the form. Be sure to sign and date item 10.

You must also complete a separate Form 4B for each supervised experience you list on the Applicant Experience Record (Form 4).

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This form must be submitted directly by the supervisor. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section and send the entire form and a copy of Appendix A (HTML | PDF) to your supervisor. If your supervisor is deceased, a licensed professional colleague may submit this form to verify your supervised experience. Be sure to sign and date item 7.
  • Section II: The supervisor must complete this section, sign and date the form and return the entire form directly to the Office of the Professions at the mailing address at the end of the form. If the supervisor is deceased the Form 4B may be completed by an LCSW who must provide the qualifications of the supervisor, the dates and frequency of the supervision, and attest to the accuracy of the information and the applicant's supervised experience.

The psychotherapy log should be completed weekly to record client contact hours and supervision hours. The completed log should be retained by the qualified supervisor who is responsible for the client contact hours and supervision of the applicant. The State Board for Social Work may request the supervisor to submit the completed log to clarify supervised experience.

Please photocopy this form as needed.

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This form is for applicants seeking licensure in New York State by endorsement of a license to practice clinical social work issued in another jurisdiction. You must have at least 10 years of licensed experience in clinical social work, in the 15 year period prior to applying for licensure in New York State.

Complete and send both pages of this form directly to the Office of the Professions at the address at the end of the form. Be sure to sign and date item 9.

You must also complete a separate Form 4F for each colleague you list on the Endorsement Applicant Experience Record (Form 4E).

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This form is for applicants seeking licensure in New York State by endorsement of a license to practice clinical social work issued in another jurisdiction. You must have at least 10 years of licensed experience in clinical social work, in the 15 year period prior to applying for licensure in New York State.

This form must be submitted by the licensed colleague who is attesting to your experience as a licensed clinical social worker in another jurisdiction. The Office of the Professions will not accept this form if submitted by the applicant.

  • Section I: Complete this section and send the entire form to the licensed colleague who will attest to your experience as a licensed clinical social worker in another jurisdiction. Be sure to sign and date item 6.
  • Section II: The licensed colleague who will attest to your licensed experience must complete this section and return both pages of the form directly to the Office of the Professions at the address at the end of the form.

A separate Form 4F must be submitted for each licensed colleague listed on the Endorsement Applicant Experience Record (Form 4E)

Important Information About Electronic Verification of Experience
The Office of the Professions (OP) will accept experience forms directly from supervisors that meet certain criteria. More information can be found here.

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This form must be submitted directly by the supervisor. The Office of the Professions will not accept this form if submitted by the applicant.

This form must be submitted if your experience was completed outside of New York State. If your supervisor is licensed by the State Education Department to supervise the provision of psychotherapy services by an LMSW, the Form 4Q is not required.

  • Section I: Complete this section before giving the entire form and a copy of Appendix A ( PDF 10 KB) to your supervisor.
  • Section II: Your supervisor must complete this section, sign the attestation, and return both pages of this form directly to the Office of the Professions at the address at the end of the form.

Please photocopy this form as needed.

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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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This form is not for all applicants. Use this form ONLY if you are applying/have applied for a New York State Limited Permit as a Licensed Clinical Social Worker 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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This form will not be reviewed if submitted after the experience has been completed or if the experience will be outside of New York State.

  • Section I: Complete this section and send the entire form and a copy of Appendix A to your proposed supervisor. Be sure to sign and date item 9.
  • Section II: The proposed supervisor must complete this section.

Return the completed form with the $10 fee to the Office of the Professions at the mailing address at the end of the form.

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This form is not for all applicants. Use this form only if you are applying for an exemption to the requirement to complete training or coursework in the identification and reporting of child abuse because your practice does not involve professional contact with persons under the age of 18 and persons 18 or older with a handicapping condition who reside in a residential care school or facility.

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