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Get Endorsement Applicant Experience Record - Office Of The ... - Op Nysed

Experience Record This form is for applicants seeking licensure in New York State by endorsement of a license to practice Psychoanalysis issued in another jurisdiction. You must have at least 5 years of licensed experience in Psychoanalysis in the 10 year period prior to applying for licensure in New York State. Applicant Instructions 1. Complete both pages of this form. In item 3, enter your name exactly as it appears on your Application for Licensure (Form 1). Be sure to sign and date item 8.

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