Indiana Administrative Code
Title 852 - INDIANA OPTOMETRY BOARD
Article 1 - GENERAL PROVISIONS
Rule 17 - Limited License
Section 17-1 - Application file; contents
Universal Citation: 852 IN Admin Code 17-1
Current through March 20, 2024
Authority: IC 25-24-1-1
Affected: IC 25-24-1-3.2
Sec. 1.
(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.
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