PLAR Bridging Post Test Application 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) The email address you provide will be the address to which all correspondence from NACOR will be sent. Please add jhay@nacor.ca to your safe sender’s list. You are responsible for informing the NACOR office of any change in personal information.Please indicate in which province you are completing PLAR(Required)Select OneAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonDate of Reasons & Decisions Letter Day Month Year CGA Applicant IDfor office use only Please select all Post-Test(s) you wish to complete(Required) Legislation Communication Professionalism Infection Control Equipment use - eyeglasses Equipment use - contact lenses Anatomy and Pathology Optics Critical thinking Dispensing eyeglasses - Course #1 Dispensing eyeglasses - Course #2 Dispensing contact lenses - Course #1 Dispensing contact lenses - Course #2 The Intake Interview Screening Tests Refracting Developing Refractive Specifications Low Vision Personal Affidavit – Please read carefully and agree to each of the followingConsent(Required) I understand that NACOR will notify the province in which I am undertaking PLAR when I have completed and passed a post-test and I hereby give my permission.(Required)Consent(Required) I understand that failed post-test marks will only be sent to me, and the province will not be notified of failed attempts.(Required)Consent(Required) I understand that NACOR will only release to me my final score and that my actual test will not be available for review.(Required)Consent(Required) I understand that in order to process my application and administer the post-test(s); NACOR will collect some personal information about me (e.g. name and contact information). 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 post-test(s).(Required)Consent(Required) I understand that the province in which I am undertaking PLAR 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 in which I am undertaking PLAR has absolute discretion to accept or reject this application.(Required)Examination FeesLegislation Price: Communication Price: Professionalism Price: Infection Control Price: Equipment use: eyeglasses Price: Equipment use: contact lenses Price: Anatomy and Pathology Price: Optics Price: Critical Thinking Price: Dispensing eyeglasses: Course One Price: Dispensing eyeglasses: Course Two Price: Dispensing contact lenses: Course One Price: Dispensing contact lenses: Course Two Price: The Intake Interview Price: Screening Tests Price: Refracting Price: Developing Refractive Specifications Price: Low Vision Price: British Columbia Tax Price: $ 0.00 CAD Alberta Tax Price: $ 0.00 CAD Manitoba Tax Price: $ 0.00 CAD Saskatchewan Tax Price: $ 0.00 CAD Nova Scotia Tax Price: $ 0.00 CAD Newfoundland & Labrador Tax Price: $ 0.00 CAD New Brunswick Tax Price: $ 0.00 CAD Nunavut Tax Price: $ 0.00 CAD Northwest Territories Tax Price: $ 0.00 CAD Yukon Tax Price: $ 0.00 CAD PEI Tax Price: $ 0.00 CAD Quebec Tax Price: $ 0.00 CAD Ontario Tax Price: $ 0.00 CAD TotalForm Total Credit Card(Required) MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name
