Form 08-4232c - Verification Of Nbeo Examination
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1State of Alaska
Department of Community and Economic Development
Division of Occupational Licensing
Board of Examiners in Optometry
P.O. Box 110806, Juneau, Alaska 99811-0806
(907) 465-2580
E-mail: license@dced.state.ak.us
VERIFICATION OF NBEO EXAMINATION
I,
, hereby certify that
Printed Name
I am scheduled to take the next offered NBEO examination.
I have passed part(s)
I
II
III
TMOD
I am scheduled to take part(s)
III on
Date
TMOD on
Date
I am awaiting the results of the NBEO examination, part(s)
which I took on
.
Date
I further certify that I have requested an official NBEO Grade Report on parts which I have passed, to date, to be
submitted to the board. Upon passage of all parts of the NBEO a FINAL GRADE REPORT will be submitted by
the NBEO.
Signature
SUBSCRIBED AND SWORN before me, a Notary Public in and for the State of
this
day of
,
.
Notary Public
My Commission Expires:
08-4232c (Rev. 1/00)
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