Personal information First Name Middle Name Last Name Suffix (None) II III IV Jr. Sr. Contact Information Email Confirm Email Phone format: 123-123-1234 Mobile Phone format: 123-123-1234 Country Canada Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Terr Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Dem Rep Of The Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Is (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Terr Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Is and McDonald Is Holy See (Vatican City) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Dem People's Rep Korea, Rebublic Of Kuwait Kyrgyzstan Lao People's Dem Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Fed States Of Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the SSI Spain Sri Lanka St Vincent and Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay US Minor Outlying Islands Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, US Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Home Address City Province - Select an option - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Postal Code Demographic Information School (None) Aston University, MI, USA Chicago College of Optometry, Chicago, IL, USA Illinois College of Optometry, Chicago, IL, USA Indiana University, Bloomington, IN, USA Inter-American University of Puerto Rico (IAUPR Optometry) International Optometric Bridging Program, U of Waterloo MCPHS University Michigan College of Optometry at Ferris State University Midwestern University - Arizona College of Optometry, Glendale, AZ, USA New England College of Optometry, Boston, MA, USA Northeastern State University - Oklahoma College of Optometry Nova Southeastern University, Fort Lauderdale, FL, USA Ohio State University, Columbus, OH, USA Ontario College of Optometry, Toronto, ON Pacific University, OR, USA Salus University Pennsylvania College of Optometry, Philadelphia, PA, USA Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, CA, USA Southern College of Optometry, Memphis, TN, USA State University of New York, NY, USA Université de Montréal, Montréal, QC University of Alabama, Birmingham, AL, USA University of California, Berkley, CA, USA University of Houston, Houston, TX, USA University of Missouri, St. Louis, MO, USA University of Pikeville - Kentucky College of Optometry University of the Incarnate Word, San Antonio, TX, USA University of Toronto, Toronto, ON University of Waterloo, Waterloo, ON Western University of Health Sciences TopClass None Expected Graduation Year Language Preferences English French Languages Spoken (None) Akan (Twi) Albanian American Sign Language Amharic Arabic Armenian Atikamekw Bengali Bosnian Bulgarian Cantonese Cree Creoles Croatian Czech Dutch English French German Greek Gujarati Hebrew Hindi Hungarian Ilocano Innu/Montagnais Inuktitut Italian Japanese Khmer (Cambodian) Korean Kurdish Lao Macedonian Malayalam Mandarin Na-Dene Nepali Ojibway Oji-Cree Other Aboriginal Languages Other Languages not listed Other Signed Languages Panjabi (Punjabi) Pashto Persian (Farsi) Polish Portuguese Quebec Sign Language Romanian Russian Serbian Serbo-Croatian Sinhala (Sinhalese) Slovak Somali Spanish Tagalog (Pilipino, Filipino) Tamil Telugu Tigrigna Turkish Ukrainian Urdu Vietnamese Yiddish Password Password The password must be at least 8 characters long. 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