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A fee applies; the amount is printed on the form.
Name: the name listed on your application for licensure, the name on your photo identification, and the name listed on your NCLEX application must all match exactly.
Affidavit: page 4 holds the Affidavit with Acknowledgement; you must sign and date it in the presence of a Notary Public.
Ink: you must answer all questions in ink (pen or printer).
Questions 10 to 14: if you answer "Yes" to any of them, 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 | Rev 11/19 |
| Issuing agency | New York 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, Form 1, Nurse Form 1Nys, Application for Licensure |
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