Get Form 5c

Filling out the Form 5c is an essential step for applicants seeking a limited residency permit for podiatric licensure in New York State. This guide is designed to provide clear instructions on how to effectively complete the form online, ensuring all necessary information is submitted correctly.

Follow the steps to successfully complete the Form 5c online.

1. Click the ‘Get Form’ button to access the online version of the Form 5c.
2. Begin with Section I, filling out your applicant information. You will need to provide your daytime phone number, email address, and other personal details. Ensure that all fields are filled completely and accurately.
3. Indicate whether you are applying for an original permit or for a renewal by checking the appropriate box. Be aware of the fees associated with your application: $105 for an original application and $50 for a renewal.
4. In Section II, your prospective employer must fill in their information. This includes the facility name, address, and contact details. Ensure that the supervising podiatrist also signs this section.
5. Confirm your citizenship or immigration status by checking the appropriate box and providing your alien registration number if applicable.
6. Complete the affidavit and acknowledgment section, which requires notarization. Make sure to sign and date this section before it is notarized.
7. Before submitting, ensure you have all required documentation ready, including your Application for Licensure and evidence of training in child abuse reporting.
8. Once all sections are filled out and reviewed, you can save your changes, download, or print the Form 5c for submission. Remember to send the form along with your payment (check or money order) to the designated address.

Start completing your Form 5c online today!