Examination Application Form Personal InformationFull Name(Required) First Middle Initial Last Maiden Mailing Address(Required) Suite/Apt & Street Address OR PO Box Number City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Contact InformationPhoneEmail(Required) NACOR will contact you by email when examination results are available. Please add jhay@nacor.ca to your safe sender’s list. The name on your Certificate of Completion will appear exactly as you’ve provided on this application. You are responsible for informing the NACOR office of any changes to your personal information.ExaminationDate & Location(Required)Please enter the date and location for which you are applying.View all dates and locations hereProvince you are going to apply for licensing(Required)Select OneAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandSaskatchewanExamination Type(Required)Select Type of ExaminationEyeglass Examination - $875.00Contact Lens Examination - $875.00Eyeglass & Contact Lens Examinations - $1,750.00Have you previously attempted the Eyeglass Examination?(Required) Yes No Have you previously attempted the Contact Lens Examination?(Required) Yes No Where have you received your training(Required)Select OneCompleted PLARBC College of OpticsCCNBDouglas CollegeGeorgian CollegeLa CiteNAIT FrenchNAIT Optical SciencesNBCCOulton CollegeSAITSeneca CollegeStenberg CollegeVancouver Community CollegeCourse End Date Day Month Year Provincial Requirements in Order to be Eligible to Write the Exam(s)Candidates who will be applying for registration in Alberta must be registered as a Provisional Optician with the College of Opticians of Alberta (COA). For further information on becoming registered as a Provisional Optician please visit the COA’s website at albertaopticians.ca or email info@albertaopticians.ca Candidates who will be applying for registration in Saskatchewan must be registered as a Restricted Optician or Restricted Contact Lens Practitioner with the Saskatchewan College of Opticians (SCO). For further information, on becoming registered as a Restricted Optician or Restricted Contact Lens Practitioner, please contact the SCO by email at office@scoptic.ca. Candidates who will be applying for registration in Ontario must be registered as an Intern Optician with the College of Opticians of Ontario (COO). For further information on becoming registered as an Intern, please visit the COO’s website at collegeofopticians.ca or email registration@collegeofopticians.ca Candidates who will be applying for registration in New Brunswick must be registered as Apprentice, or if from QC, as a Pre-Candidate with the Opticians Association of New Brunswick (OANB). For further information on becoming registered as a Pre-Candidate contact the OANB at: nbgdo@nbnet.nb.ca Personal Affidavit – Please read carefully and agree to each of the followingConsent(Required) I agree that all information provided on this application is true.(Required)Consent(Required) I agree and understand that NACOR will forward all examination results to the province that I will apply for licensing with and hereby give my permission.(Required)Consent(Required) I agree and understand that in order to process my application, administer the examination and provide me with my results, NACOR will collect some personal information about me (e.g. name, address, program results, and examination results). I agree to NACOR collecting, using, and disclosing personal information about me, as it deems necessary for the processing and administration of my application and examination.(Required)Consent(Required) I agree and understand that the province I will be applying for licensing with will verify all information I have declared on this application and hereby give my permission for the NACOR office to release and to discuss this information with this province. The province I will be applying for licensing with has absolute discretion to accept or reject this application.(Required)Examination AccommodationsIf you require any accommodations during your examination due to disability or extenuating circumstances a written letter outlining your requested accommodations must be included with your application form. Official documentation confirming your circumstances must be included with your request (for example, if you received accommodations while in school, please submit a copy of the service plan you received). A candidate with a disability should outline their specific accommodation needs with any appropriate supporting documentation but is not required to disclose their disability to NACOR. NACOR reserves the right to request additional information or supporting documentation if NACOR determines this to be necessary to make a decision. Upload Accommodation Documents HereAccepted file types: pdf, doc, docx, pages, ppt, mp4, mov, Max. file size: 128 MB.Examination FeesChoose Examination to get the TotalTotal Eyeglass Examination TotalTotal Contact Lens Examination TotalTotal Eyeglass & Contact Lens Examination TotalTotal Credit Card(Required) MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name
