Original License Application - Maryland Board Of Examiners In Optometry Page 16
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16ORIGINAL APPLICATION FOR LICENSURE CHECKLIST
Use this checklist as a guide in determining the submission of required documentation.
APPLICATION SIGNED AND NOTARIZED ________________
____________________
YES
NO
CHECK FOR $300.00
___________________
___________________
YES
NO
UNDER GRADUATE TRANSCRIPTS
____________________
___________________
YES
NO
OPTOMETRY TRANSCRIPT
______________
____________________
YES
NO
RECENT PHOTOGRAPH
__________________
___________________
YES
NO
LETTERS OF RECOMMENDATION (NEED 4 LETTERS) _______________
_________________
YES
NO
PHOTOCOPY OF OPTOMETRY DIPLOMA
_____________________
_______________________
YES
NO
NBEO SCORES
PART I ________________
PART II ________________
PART III ________________
TMOD __________________
LICENSURE AFFIDAVITS FROM EVERY STATE WHERE YOU HAVE BEEN LICENSED
_________ ___________
YES
NO
MARYLAND LAW EXAM COMPLETED ____________________
_____________________
YES
NO
DPA / TPA APPLICATION SIGNED AND NOTARIZED ___________
________________
YES
NO
CURRENT CPR CARD_____________________
_______________________
YES
NO
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