All applicants for licensure must complete this form. A fee applies; the amount is printed on the form.
In ink: You must answer all questions in ink (pen or printer) and provide all information requested unless otherwise indicated.
Notary: You must sign and date the Affidavit on this form in the presence of a Notary Public.
Name: If your name does not exactly match in all instances it will delay your authorization to test (ATT).
Questions 10-14: If you answer "Yes" to any questions numbered 10-14, submit a letter giving a complete detailed explanation.
| Question | Answer |
|---|---|
| Form Name | Nurse Form 1 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 12 min |
| Edition | 11/19 |
| Issuing agency | The State Education Department, Office of the Professions |
| Where to send | If you are submitting an initial Form 1: New York State Education Department, Office of the Professions, PO Box 22063, Albany, NY 12201 |
| Other names | Nurse Form 1, Nurse Form I, NYSED Form 1, Application for Licensure |
New York Nurse Form 1 isn’t the one you’re looking for?