Application Fee Waiver Request Form

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Optometry School

WAIVER TYPE: Please check the box that indicates the basis for your request. Attach official documentation of the waiver you have selected. Without official documentation, your request will not be considered. This form alone does not constitute a request for an application fee waiver. In addition, fee waiver requests are not guaranteed and the Board will determine if a request is accepted or denied. If the waiver request is denied, you will be contacted to pay the application fee.

Waiver Type

Initial Application for Licensure by Exam (NBEO)

Initial Application for Licensure by Endorsement

Attach Official Documentation

You can add up to 100mb of files in a .pdf format.
Unlimited number of files can be uploaded to this field.
100 MB limit.
Allowed types: pdf.

I certify that the information provided is complete and correct to the best of my knowledge. I understand that any misrepresentation, falsification, or failure to supply required information may result in rejection of this request and application.

I agree - I understand that by signing, my electronic signature is the legal equivalent of my handwritten signature and I consent to be legally bound to this agreement. I further agree my signature on this document is as valid as if I signed the document in writing. Under penalty of perjury, I herewith affirm that my electronic signature was signed by myself with my full knowledge and consent.

Signature

Sign above