Section 852IAC1-17-1. Application file; contents

   (a) An applicant for a limited license shall submit the following:

(1) An application filed on a form prescribed by the board and provided by the agency.

(2) The fee required by 852 IAC 1-10-1.

(3) Official transcripts, certified by the school, recording courses, grades, certificates, and degrees earned in an optometry school accredited by the Accreditation Council on Optometric Education. If not in English, the applicant must provide an official translation.

(4) One (1) passport-quality photograph taken not earlier than one (1) year prior to the date of application, dated and signed on the back in the applicant's handwriting, "I certify that this is a true photograph of me.".

(5) A copy of the applicant's curriculum vitae.

(6) A statement from the dean at Indiana University that shall include the date of faculty appointment and subject or subjects being taught.

(7) Verification of licensure status provided to the board directly by the appropriate agency in each state or country where the applicant holds or has held a license to practice optometry.

(8) An applicant must provide verification of licensure directly from the appropriate agency in the state or country where the applicant holds a current license to practice optometry.

(9) Verification of areas of examination, type of examination, pass-fail criteria, and the applicant's score in each area of the examination provided to the board directly by the state or country in which the applicant took the examination.

  (b) The dean at Indiana University School of Optometry may be contacted in order to validate the suitability of the applicant for a limited license. (Indiana Optometry Board; 852 IAC 1-17-1; filed Jan 6, 2003, 10:23 a.m.: 26 IR 1561; readopted filed Dec 1, 2009, 9:13 a.m.: 20091223-IR-852090781RFA; readopted filed Jun 16, 2010, 12:14 p.m.: 20100630-IR-852090781RFA; filed Aug 30, 2012, 2:03 p.m.: 20120926-IR-852120164FRA)