Standard Application for Specialty Certification

"*" indicates required fields

If you haven’t done so already, please review the Standard Application Requirements.

Before uploading your files, please add your last name to the beginning of each one. For example, “yourlastname-acmo-exam.pdf” and “yourlastname-od-license.png” will help speed up processing.

Hidden

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: 12.

Please include: ACMO Score Results, State Optometry License, Letter of Recommendation, Certificate of Residency Completion, Self-Query of the NPDB, Documented Significant Practice, O.D. Degree, Comprehensive CV and Cover Letter with Summary and Contact Information.

A letter of confirmation from your credentialing committee can substitute for several items above.

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*

Standard Application ($500)

Total

Credit Card*

Card Details

Cardholder Name