Fillable Form 08-4232 - Optometry License Application printable pdf download

TATE

ALASKA

Department of Commerce, Community, and Economic Development

Division of Corporations, Business and Professional Licensing

Board of Examiners in Optometry

State Office Building, 333 Willoughby Avenue, 9th Floor

PO Box 110806, Juneau, AK 99811-0806

Phone: (907) 465-2550

Email: license@alaska.gov

Website: ProfessionalLicense.Alaska.Gov/BoardofOptometry

Optometry License Application Instructions

Alaska Statute 08.72.110 states that no person may practice optometry in the state without first obtaining an Alaska

license. The State of Alaska provides for licensure of optometrist with therapeutic authority only and no longer offers a

restricted license for new applicants.

Please read the application and instructions carefully. Failure to do so may cause additional correspondence and delay

in the processing of your application.

1. Allow 6 to 8 weeks for processing the application from the time your file is complete. Please read the application

and instructions carefully. Failure to do so may cause additional correspondence and delay the processing of

your application. All required forms and documentation must be mailed to the Division directly from the required

source or they will not be accepted. To avoid delays, do not provide a mailing envelope to the other agencies or

sources that are required to mail documents directly to the Division.

2. Appropriate fees must accompany applications before initial screening can begin. All fees may be paid with

check or money order made payable to the State of Alaska, or by credit card. To pay by credit card, use the

attached credit card payment form.

3. If any of the required documents (i.e., transcripts, verifications of licensure, etc.) will be issued under your

former name, submit marriage license and/or court documents that are notarized as a “certified true copy of the

original document.”

4. An incomplete application or any unusual circumstances noted in the application may require additional

processing time. Please print legibly, or type.

5. While we understand your desire to conclude this process as quickly as possible, our licensing staff is

responsible for reviewing many files and cannot complete the application process if required documents are

missing. It is your responsibility to ensure those documents are received by our office.

6. The application review process is defined by the requirements set forth in state law. The Board and its staff

must comply with those laws in processing applications.

7. The Board conducts a thorough evaluation of education, training, employment or work history, malpractice

history and any criminal or disciplinary history. We recommend you do not make commitments for loans,

practice start dates, home purchases, etc., based on the expectation of licensure. The Board will not accelerate

one application over others nor will it forego any elements of its screening process.

8. If you received this application from a source other than directly from the Division or its official website, the

application may be outdated or not an official version. To ensure you have the official version, please contact

the Division. Application forms will be rejected if not on the current version.

IT IS ILLEGAL TO PRACTICE AS AN OPTOMETRIST IN ALASKA WITHOUT A VALID LICENSE

08-4232

Rev. 12/01/16

Application Instructions

Form 08-4232 - Optometry License Application

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