Optician Registration Application Form Page 6
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10SECTION 5 EDUCATION continued
5b. Education other than Opticianry: Have you completed any education other than Opticianry?
Yes
No
If yes provide the information requested below. If no proceed to section 6. Write corresponding code in box
Level of
Field of
Program Name
Canadian Educational
Prov./State/Terr.
Country
Date of
Education
Study
Institution
Graduation
mm/dd/yyyy
1.
2.
3
4.
5.
Level of Education
01
Diploma
03 Master’s Degree
05 Doctorate
07 Entry to Practice Post Diploma Certificate/Courses
02
Baccalaureate
04 Professional Doctorate
06 None of the Above (Specify)
Field of Study
01 Biological and Biomedical Sciences
07 Health Administration/ Management
13 Physical Sciences
02 Business, Management, Marketing and Related
08 Health Professions and Related Clinical Services
14 Public Administration
03 Education
09 Kinesiology and Exercise Science
15 Public Health
04 Engineering
10 Law
16 Psychology
05 General Rehabilitation Science
11 Mathematics, Computer Information Sciences
17 Social Sciences, Arts and Humanities
06 Gerontology
12 Medical Laboratory Science
18 Other Field of Study (Specify)
SECTION 6 CITIZENSHIP/ IMMIGRATION STATUS
You are required to provide proof of your Canadian citizenship or permanent residency or employment authorization.
Are you a Canadian citizen?
Yes
No
If not Canadian citizen, are you a permanent resident of Canada?
Expiry Date:
Yes
No
Expiry Date:
Yes
No
If not permanent resident, do you have employment authorization under the
Immigration and Refugee Protection Act?
SECTION 7 CONDUCT
If you have answered YES to any of the questions below, please provide full details including any relevant documentation. For further guidance, please also
click here
to refer to the Registration Policy dealing with 'Convictions, Findings and Ongoing Proceedings'.
Yes
No
7a. Have you ever been found guilty of an offense related to the regulation of the practice of opticianry?
Yes
No
7b. Have you been found guilty of a criminal offense that has not been previously reported to the College?
Yes
No
7c. Has a finding of professional negligence or malpractice, which may or may not relate to your suitability to practice, been
made against you?
Yes
No
7d. Have you ever been refused registration in an opticianry regulatory body?
Yes
No
7e. Have you ever had a finding of or are you currently facing a proceeding for professional misconduct, incompetency,
incapacity, or a similar issue in relation to opticianry in Ontario or another jurisdiction?
Yes
No
7f. Have you had a finding of, or are you currently facing a proceeding for professional misconduct, incompetency, incapacity or
a similar issue in another profession other than opticianry in Ontario or elsewhere?
Page 5 of 9
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