Form 08-4232 - Optometry License Application Page 3
Download a blank fillable Form 08-4232 - Optometry License Application in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 08-4232 - Optometry License Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18Application for Licensure Checklist
Document:
Provided by:
Completed application, with notary stamp overlying recent photo
You provide
Authorization for Release of Records
You provide
You request, school mails
Optometry education transcripts
directly to our office
Three notarized letters of reference
You request, references
mail directly to our office
(Examination applicants only)
Verification of Licensure from any state, territory, province you hold,
You request, jurisdictions
or have ever held, a license
mail directly to our office
You request, other agency
Verification of licensure/employment with a federal agency
provides document
You request, agency mails
NBEO / TMOD / PAM exam scores
directly to our office
7 hours of injection education certificate
You provide
Copy of DEA certificate (if you have one)
You provide
Proof of 36 hours of CE if you passed the NBEO two or more years
before the date of application.
You provide
(Examination applicants only)
3,120 hours of clinical practice verification
You request, other agency
provides document
(Credentials applicants only)
Charging and closing court documentation for any “Yes” answers.
You provide or the
healthcare provider submits
If the “Yes” answers are health-related, provide a “fit to practice” letter
directly to our office
from your healthcare provider.
Written explanation, signed and dated, for any “Yes” answers.
You provide
Fees enclosed with application.
You provide
08-4232
Rev. 12/01/16
Application Checklist
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal