Applying for the Psychoanalytic License or Certification
Listed by state to date
New York State
Download the New York State psychoanalyst license application forms here: http://www.op.nysed.gov/prof/mhp/psyanllic.htm
This link takes you to Psychoanalysis Application Forms, with instructions and links for each form. Under the Mental Health Practitioners sidebar on the left, scroll down for the Psychoanalysis tab.
Download License Requirements and Application Forms.
Psychoanalyst Application Packet has all the instructions and forms in one pdf. Read through carefully to decide which path best fits your education and clinical experience. Print out each form.
Form 1-Application for Licensure: Send to New York State with your photo and a check for $345.00. Also fill out Form 4 with the names of 3 colleagues or supervisors (these will be endorsers) and send to the state with Form 1. If you work with children also send the certificate of completion of the child abuse course. If you do not work with children, send the certificate of exemption to the state.
Form 2-Certification of Psychoanalytic Study: Complete Section I and send entire form to your institute.
Form 2A-Certification of Graduate Study: You will need at least two copies of this form. Complete Section I of each copy and send one entire copy to your graduate school and one to the institute from which you graduated.
Form 4-Applicant Experience and Endorsement Record: Complete form and send to the Office of Professions (address at bottom of form).
Form 4B-Certification of Supervised Experience: List 3 colleagues or supervisors (endorsers) who can verify that you have been in practice full-time for 7 years or the equivalent.
Child Abuse Certificate of Exemption Form: Fill out and send to NYS if you do not work with children.
Forms that must be notarized can be taken to your bank. There should be no fee.
For more information, contact the state at 518-474-3817 or email@example.com.
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