Form Dh-Mqa 1128 - Application For Licensure As Certified Optometrist (Page 3 of 11) in pdf

Form Dh-Mqa 1128 - Application For Licensure As Certified Optometrist Page 3

FAX: (305) 273-1338

EDUCATION CREDENTIAL

CENTER FOR APPLIED RESEARCH,

EVALUATORS, INC.

EVALUATION & EDUCATION, INC.

P. O. BOX 92970

P.O. BOX 18358

MILWAUKEE, WI 53202-0970

ANAHEIM, CA 92817

PHONE: (714) 237-9272

PHONE: (414) 289-3400

FAX: (414) 289-3411

FAX: (714) 237-9279

WORLD EDUCATION SERVICES, INC.

INTERNATIONAL EDUCATION

RESEARCH FOUNDATION, INC.

P.O. BOX 01-5060

P. O. BOX 3665

MIAMI, FL 33101

CULVER CITY, CA 90231

PHONE: (305) 358-6688

PHONE: (310) 258-9451

FAX: (310) 342-7086

FOREIGN ACADEMIC CREDENTIALS

WORLD EDUCATION SERVICES, INC.

SERVICES, INC.

BOWLING GREEN STATION

P. O. BOX 400

P.O. BOX 5087

GLEN CARBON, IL 62034

NEW YORK, NY 10274-5087

PHONE: (618) 307-6036

PHONE: (212) 966-6311

(618) 656-5291

FAX: (212) 739-6100

FAX: (618) 656-5292

WEB SITE: You can also visit the board’s web site for additional information at

PLEASE NOTE--YOUR APPLICATION IS NOT CONSIDERED COMPLETE UNTIL ALL SUPPORTING DOCUMENTS

AND FEES HAVE BEEN RECEIVED BY THIS OFFICE.

Note: If an applicant has not been issued a Social Security number, the department may process the application. However,

Only a temporary license, which expires in 30 days, will be issued. Upon receipt of a Social Security number a new license

will be issued.

Computer Based Test Information

Once you have received your notification of eligibility from the board office, you may contact Prometric to pay the CBT examination

fee and schedule your examination.

COMPUTER BASED TEST FEES

Please Note—Fees are required in addition to the fees already submitted to the board.

Optometry Laws/Rules Fee – $58.00

•

This fee shall be paid to Prometric.

•

The fee may be paid by Visa, MasterCard, American Express, or electronic check.

•

Payment will be due at the time of scheduling.

SCHEDULING:

•

You must schedule your examination appointment with Prometric. You may contact Prometric via telephone or Internet at

the contact information listed on the last page of the Candidate Information Booklet (CIB).

•

When contacting Prometric, you must select/state that you are taking a “Florida Department of Health” examination.

•

You will be required to provide your social security number (as your testing/eligibility ID) in order to schedule your

examination.

•

All examination dates, times, and locations will be scheduled on a first-come first-serve basis.

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P a g e s

DH-MQA 1128, Revised 07/16

Rule 64B13-4.004 & 64B13-10.001, F.A.C.

Form Dh-Mqa 1128 - Application For Licensure As Certified Optometrist Page 3

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