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The University of the State of New York

Certified Public Accountant

THE STATE EDUCATION DEPARTMENT

Office of the Professions

Form 2

Division of Professional Licensing Services

Certification of Professional Education

All Submissions Require an Official Transcript or Marksheets

Applicant Instructions

Complete Section I. In item 3, enter your name exactly as it appears on your Application for Licensure (Form 1). Be sure to sign and date item 10.

Send the entire form to the institution you attended and ask the Registrar to complete the appropriate parts of Section II and forward the completed

form along with any required documentation directly to the Office of the Professions at the address at the end of the form. Be sure to include any

fee required by the institution. This form will not be accepted if submitted by the applicant. The Department does not accept transcripts in

sealed envelopes if they are mailed by the applicant. This includes forms and transcripts or marksheets sent to the applicant via courier.

Note: A separate Form 2 must be submitted for each institution you attended.

Section I: Applicant Information

Social Security Number

Birth Date

Month

Day

Year

(Leave this blank if you do not have a U.S. Social Security Number)

Print Name Exactly As It Appears On Your Application for Licensure (Form 1)

Last

Telephone/E-Mail Address

First

Daytime Phone

Middle

Area Code

Phone Number

Mailing Address

(You must notify the Department promptly of any address or name changes.)

E-Mail Address (Please print clearly)

Line 1

Line 2

Line 3

City

State

Zip Code

Country/

Province

Institution attended: _______________________________________________________________________________________________________

Print name under which degree was awarded: __________________________________________________________________________________

Dates of attendance from: ______________________________ to: ______________________________

Name of degree/diploma issued: _______________________________________________________ Date awarded: _______ / _______ / _______

I request and give my permission to the Institution listed in item 6 above to attach to this form an official transcript or marksheets and mail it to the

New York State Education Department and to release any other information required by the State Education Department in connection with my

application for licensure.

Applicant's signature: _______________________________________________________________________ Date: _______ / _______ / _______

Section II: Certification of Professional Education

INSTRUCTIONS TO INSTITUTION REGISTRAR:

Complete Part A, B, or C to document the applicant’s education.

Sign and date the certification and return both pages of this form and an official transcript or marksheets directly to the Office of the Professions at the

address at the end of the form. Do not return this form to the applicant. This form will not be accepted if returned by the applicant.

Name of applicant: _________________________________________________________________________________________________________

(See Section I, item 7)

Certified Public Accountant Form 2, Page 1 of 2, Rev. 6/16