Special Application on Merit for Specialty Certification

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If you haven't done so already, please review the Special Application on Merit Requirements.

Before uploading your files, please add your last name to the beginning of each one. For example, “yourlastname-cover-letter.pdf” and “yourlastname-cv.doc” will help speed up processing.

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Date

First Name*

Last Name*

Middle Name

Your Email*

Application Files*

Drop files here or

Accepted file types: doc, docx, gif, jpeg, jpg, pdf, png, xls, xlsx, Max. file size: 8 MB, Max. files: 10.

Please include a Cover Letter and CV documenting some or all of the following: National Recognition for Advanced Competence in Medical Optometry, Lectures, Workshops, Educational Meetings, Publications, Supervision of Residents, TMOD or ACMO Exams, Fellowship in the American Academy of Optometry, Fellowship in the Optometric Retina Society, Fellowship in the Optometric Glaucoma Society, Diplomate in the Ocular Disease Special Interest Group, Certification in Ophthalmology and/or Research in Medical Treatment of Ocular Disease.

Attestation*

I attest that the information submitted in this application is true and correct.

Authorization*

I authorize ABCMO to make any inquires needed to verify the information provided above.

Application Fee*

Special Application ($500)

Total

Credit Card*

Card Details

Cardholder Name