Recertification Exam Application

Recertification Exam Application

Process I for recertification
When: The Certification Exam is available April 1 - December 31

Where: The written exam is administered at a Meazure Learning testing site (US & Canada Only).

Upon application approval, candidates will be contacted directly by Meazure Learning to schedule the exam.

NOTE: Please read the "Exam Candidate Handbook" for full exam timeline and details.

A processing fee of $300.00 will be charged for all rejected applications.

Written Exam = $1000 USD

The Exam is only available in English.

*Translators and/or dictionaries are not allowed*
Name*

First NameMiddle NameLast Name
Certification Number:*
Cert Year-ID # (YY-XXX)
Date of Birth*

MonthDayYear
Date
Personal E-mail (NEBO Comm. Only)*
example@example.com
Personal Phone Number (NEBO Comm. Only)*

Area CodePhone Number
Business Email
example@example.com
Business Phone Number*

Area CodePhone Number
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Color Copy/photo of Government issued ID*

Browse Files

Cancelof
APPLICATION STATEMENT, SIGNATURE AND DATE
Because of functional limitations imposed by disability, special arrangements will be necessary for me to complete the certification examination (If yes, please send a current letter from your licensed professional stating your needs as well as other information on separate page and attach to application.)*

YesNo
Application to this examination shall be considered without discrimination as to age, sex, race, religion, sexual orientation, national origin, handicap, or marital status.

I certify that the information supplied in this application is true and accurate to the best of my knowledge.

I also acknowledge that I have downloaded and read, in its entirety, the booklet entitled “Exam Candidate Handbook”, of the National Examining Board of Ocularists.
Signature*

Clear
Please select payment type below:

Check may be mailed to NEBO, 2050 Keokuk St., NEBO Suite, Iowa City, IA 52240

OR

Email invoice will come from Square to the email listed on this form.
Payment type: *
Should be Empty:

Recertification Exam Application

APPLICATION STATEMENT, SIGNATURE AND DATE