NY State Education Department Workshop Submission

NYSED Certification

Need to submit your Workshop attendance to the NY State Education Department? Please complete and submit the information below.

First Name(Required)

First name as it appears in your professional license.

Last Name(Required)

Last name as it appears in your professional license

Date of Birth(Required)

Street Address(Required)

No. and Street Name ONLY

Apartment/Unit

City(Required)

State(Required)

Zip Code(Required)

Date of Instruction(Required)

Please refer to your Certificate of Completion

Serial Number(Required)

Please refer to your Certificate of Completion

How can we contact you in case of a problem with your submission?

Profession Code(Required)

NYS License Number

Leave blank if you are NOT currently registered.

State of Licensure(Required)

Where did you get your original professional license?