Verification of NYS Certification

Instructions, please read. 

This form is to be used by providers who require verification of their certification for employers, potential employers, educational purposes, other states that the provider is seeking reciprocity in, or for other circumstances in which you need to prove issued certification from the State of New York.  

Verification is not provided to individual providers who are looking to find out their expiration date or to receive a new copy of their card. If you are looking for this, you should use the "Request a Duplicate Card Request Form" on our website, under EMS Forms. 

Requests for verification of certification must be submitted using this form. No requests by telephone, mail, or fax will be accepted. 

Please allow up to four weeks for processing. 

Full Name
Provider's Address
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