Application For An Optometry License - New Jersey State Board Of Optometrists Page 2
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13Verification of licensure - you must contact each state in which you hold (or have held) an optometry license (active,
inactive or expired) and request that each board mail a verification of your license directly to the: New Jersey State
Board of Optometry, P.O. Box 45012, Newark, NJ 07101. Please contact each state office to find out about the required
processing fees for verification before mailing your request.
If you answered “Yes” to any of the child-support questions, you must provide a written explanation on a separate sheet
of paper and then attach it to the application.
All applicants must complete the enclosed “New Jersey Optometry Law Examination” and return it with your application
for licensure. (If you have downloaded the application from our website, the New Jersey Optometry Law Examination
will be sent to you once the Board has received your completed application.)
Fill out the medical conditions section on this application.
Fill out the Certification and Authorization form for a criminal history record background check and mail it with the
application to the Board.
Once the entire application has been completed and signed by you, have it signed and stamped/sealed by a notary
public.
Notice
Any applicant filing an application after November 22, 2003, will be subject to a criminal history record background check
pursuant to P.L. 2002, chapter 104. Information regarding this background check will be provided to applicants.
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