Get Ny Clinical Laboratory Technologist Restricted License Form 4a 2020-2025

This guide will help you navigate the process of filling out the NY Clinical Laboratory Technologist Restricted License Form 4A online. By following these clear instructions, you can ensure that your application is completed accurately and efficiently.

Follow the steps to complete the form accurately and submit it correctly.

1. Click ‘Get Form’ button to obtain the form and open it for editing. You will need to access the necessary fields to fill in your information.
2. In Section I, provide your personal information. Enter your Social Security Number if applicable, or leave it blank if you do not have one. Fill in your birth date, name, and contact details, indicating whether they are home or business information. Ensure that your email address is clear and correctly formatted.
3. Indicate the name and title of the Clinical Laboratory Director to whom you are sending this form in the appropriate field.
4. In item 8, read the statement carefully. By signing this item, you give permission for the Clinical Laboratory Director to complete Section II and affirm that all information provided is true. Include your signature and date where required.
5. After completing Section I, send the entire Form 4A to the Clinical Laboratory Director of the training program you attended. Request that they complete Section II and return the form directly to the Office of the Professions.
6. Once you have completed and submitted the form, keep a copy for your records. You may want to download or print the filled form for future reference.

Complete your documents online to ensure a smooth application process.