OPE-SC Supervisor Verification Form

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Registered Orthopedic Technologist (ROT) Examination
Registered Orthopedic Technologist (ROT) Exam
Fill out the form below indicating your current experience to meet exam requirements along with ROT application form. Please feel free to "save" form at the bottom. You will receive a unique link to the email address provided to return as needed.

Need ROT Exam Application Form? CLICK HERE to download
Date*

MonthDayYear
Existing Member Information
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address:*
Cell Number:*

Area CodePhone Number
FINAL UPLOAD - ROT Application Form*

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Submit completed ROT form here - please verify all signatures are affixed on form Cancelof
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