Application for Optometric Residency
DIRECTIONS: Complete ALL sections below to submit your application to the NSU College of Optometry Optometric Residency Program prior to the deadline of February 1st.
Applicant's Name:
 
Current Address:
Day Phone Number:
 
Evening Phone Number:
 
Email Address:
 
Optometry School Attended:
 
Graduation Date:
 
How did you learn of the NSU Residency Program? (Please check all that apply)
Foresight Advertisement  
ASCO Residency Directory  
NSU Resident (past or current)  
AOA Residency Information Luncheon  
NSU Residency Website  
AOA News Advertisement  
AAO Residency Information Luncheon  
Other   
NSU RESIDENCY PROGRAM(S) APPLYING FOR: Please check all that apply. Send all application materials to Dr. Lori Vollmer. If you are applying to only the full Pediatrics position, you may send material directly to Dr. Jackie Rodena. You do not need to submit multiple applications, but you may need to modify the letters of recommendation if applying to both split and full pediatrics.
RESIDENCY IN PRIMARY CARE with emphasis in GERIATRICS/LOW VISION  
RESIDENCY IN PRIMARY CARE with emphasis in OCULAR DISEASE  
RESIDENCY IN PRIMARY CARE with emphasis in PEDIATRIC OPTOMETRY  
RESIDENCY IN PRIMARY CARE with emphasis in CONTACT LENSES  
RESIDENCY IN PEDIATRIC OPTOMETRY  
ARE YOU AN INTERNATIONAL APPLICANT THAT WILL REQUIRE A VISA FOR ADMISSION INTO THE PROGRAM?
Yes  
No  
HAVE YOU EVER BEEN CONVICTED IN ANY STATE OR COUNTRY OF:
A CRIMINAL OFFENSE (OTHER THAN MINOR TRAFFIC OFFENSE) WHERE YOU HAVE BEEN FOUND GUILTY BY A JUDGE OR JURY OR ENTERED A PLEA OF NOLO CONTENDRE (NO CONTEST)?
Yes  
No  
ANY OFFENSE WHERE THE RECORDS HAVE BEEN EXPUNGED OR SEALED?
Yes  
No  
ANY CONVICTION THAT YOU ARE CURRENTLY APPEALING REGARDLESS OF ADJUDICATION?
Yes  
No  
AS A RESULT OF THE CONVICTION, ARE YOU CURRENTLY INCARCERATED OR WILL YOU BE INCARCERTED UPON OR DURING YOUR RESIDENCY TRAINING?
Yes  
No  
ADDITIONAL ESSAY QUESTIONS
SO AS TO ASCERTAIN YOUR SPECIFIC INTERESTS, IN THE SPACE BELOW, PLEASE LIST ANY OTHER RESIDENCY PROGRAMS TO WHICH YOU HAVE APPLIED:

Please briefly discuss your academic performance in optometry school and your performance on the National Boards -- do you feel that your grades/scores are an accurate indicator of your abilities? Why or why not? Is there anything that you wish the committee to know about your grades or scores that might not be reflected on the official report?
What qualities do you possess that would make you a good choice for the residency position for which you are applying?
What will be your biggest obstacle in pursuing your goal to be selected for an optometric residency?
Please tell us anything else that you want us to know which may not be reflected otherwise when we review your application materials.

IMPORTANT: The save button can be used to return to the application at a later time to enter further data or correct previous entries.  Pressing "Submit" does not allow further editing of the application.

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