Form Dop - Application For Dispensing Optician License By Examination Or By Credentials - Alaska Department Of Community And Economic Development
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8DOP
STATE OF ALASKA
FOR OFFICE USE ONLY
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
ALASKA STATE BOARD OF DISPENSING OPTICIANS
P.O. BOX 110806
JUNEAU, ALASKA 99811-0806
(907) 465-5470
E-mail: license@dced.state.ak.us
APPLICATION FOR DISPENSING OPTICIAN LICENSE
BY EXAMINATION OR BY CREDENTIALS
By Credentials
$ 50.00
Nonrefundable Application Fee
(submit application)
$ 380.00
License Fee
$ 100.00
National Written Exam - Spectacles
$ 100.00
National Written Exam - Contact Lenses
$ 100.00
State Practical Exam - Spectacles
$ 100.00
State Practical Exam - Contact Lenses
By Examination
(submit application,
Enclose a check or money order payable to the State of Alaska in U.S. currency.
license and exam fees)
Spectacles
Contact Lenses
Name:
Last
First
Middle
Mailing Address:
Street Address or P.O. Box
City
State
ZIP Code
Name of Place of Employment:
Address of Place of Employment:
State
ZIP Code
Telephone Number: Day:
Evening:
Social Security Number
Date of Birth
Height
Weight
Sex
Eyes
Hair
EDUCATION:
High School Name, City and State:
Date Graduated:
Other education: School Name, City and State
APPRENTICE AND/OR WORK HISTORY: List most current employer first, include employment for past three years, or
6,000 hours of training.
Name of Optical Company
Hours Earned
Exact Dates of Training
NOTE: 6,000 HOURS OF TRAINING AS AN APPRENTICE OR LICENSED OPTICIAN MUST BE VERIFIED BY EMPLOYER
ON THE VERIFICATION OF APPRENTICE TRAINING OF WORK EXPERIENCE FORMS ATTACHED.
08-4151 (Rev. 8/00)
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