New york state dental hygiene license application

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 any suspicious communication received to the Federal Trade Commission.

Application Forms for Dental Hygienists

Dental Hygienist

Laws, Rules & Regulations News & Current Issues Restricted Certificate to Administer & Monitor Local Infiltration Anesthesia & Nitrous Oxide Analgesia School Dental Health Certificates Scope of Practice Changes Professional Practice Mandated Training Mandated Training Related to Child Abuse Mandated Training Related to Infection Control Consumer Information Contact Information License Statistics License Requirements Application Forms Restricted Anesthesia Certification Continuing Education Questions and Answers Sponsors Board Meetings

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.

Online Form 1 - Application for Licensure

All applicants for licensure must initially submit Form 1 along with the $128 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.

Form 2 - Certification of Professional Education

This form must be submitted directly by the educational institution you attended.

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, Brazil and the Philippines provided that:

*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.

Form 3 - Certification of Licensure

Use this form only if you are or have been licensed as a dental hygienist in another jurisdiction. This form must be submitted directly by the licensing authority.

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.

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:

*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.

Form 4A - Personal Affidavit of Professional Practice for Endorsement Applicants

If you are seeking licensure by endorsement, complete this form and return it to the Office of the Professions at the mailing address on the form.

Form 4B - Verification of Professional Practice

If you are seeking licensure by endorsement, complete items 1-6 of this form. Be sure to sign and date item 6 and submit the form to a dentist(s) licensed and in good standing in the state(s) in which you are currently licensed who must complete Section 2 and submit the form directly to the Office of the Professions at the mailing address at the end of the form. You may need to have more than one affidavit submitted for comprehensive certification of the required two years of professional practice. Please photocopy the form as needed.

Electronic Verification of Experience

The Office of the Professions (OP) will accept experience forms directly from supervisors provided that:

*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.

Online Form 5 - Application for Limited Permit for Dental Hygienists

All applicants for a limited permit must initially submit Form 5 along with the $50 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).

Form 5CS - Certification of Supervisor for Limited Permit

Use this form ONLY if you are applying/have applied for a New York State Limited Permit as a Dental Hygienist online.

Form 1CE - Child Abuse Certification of Exemption Form

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 of child abuse and maltreatment because the nature of your practice excludes contact with children.

Dental Hygiene Restricted Anesthesia Forms: Online Form 1 - Application for Dental Hygiene Local Infiltration Anesthesia/Nitrous Oxide Analgesia Certification

Important Notice: 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. If your registration has lapsed and you need to reregister, do not submit a Form 1. Instead, contact our customer services unit to request a Delayed Registration Application by e-mailing: op4info@nysed.gov, or by calling 518-474-3817 Ext. 570. When e-mailing, be sure to include your profession, license number, address on record, new address (if changed), date of birth and the last 4 digits of your SSN.

All applicants for certification must submit this form along with the $25 certification 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.

Dental Hygiene Restricted Anesthesia Forms: Form 2 - Verification of Education