Application for Student Status for Dispensing Opticians in Training

Name

First

Middle

Last

Address

Street

City

Postal code

Date of Birth

All applicants must provide

Certificate of completion / transcript for High School or its equivalent

Max. file size: 64 MB.

A current [within 3 months] criminal record and vulnerable sector clearance certificate

Max. file size: 64 MB.

2 passport size photos…. With signature on the back of the photos

Drop files here or

Max. file size: 64 MB, Max. files: 2.

Pay the $30.00 application fee [non-refundable]

Max. file size: 64 MB.

Supervisor(s) completed forms

Max. file size: 64 MB.

Work Location:

Company Name

Owner/Manager

Street Address

Town/City

Postal code

Phone

Course : Optical Sciences : NAIT/OAC

NAIT/OAC

Or enrolment in another program/institution accredited by NACOR

Name

Contact information

You will be notified if the course you intend to take has not been approved by the Board

Student’s Declaration:

I hereby make application to be a Dispensing Optician in Training. I understand that direct supervision by a licensed registered Dispensing Optician (or Optometrist) approved by the Board is mandatory when undertaking tasks of optical dispensing as defined in the Dispensing Opticians Act, Regulations and Standards of Practice. I understand that delegation without the direct supervision of an approved supervisor contravenes the Dispensing Opticians Act. To do so may cause my name to be removed from the student registry.

Signature
Max. file size: 64 MB.

Date