WARNING! The name and birthdate on the IDs you intend to use at the test center must match your PIN exactly or you will be denied admission to testing and forfeit your testing/application fee. All the names on your ID must be entered. If needed, several names can be entered in the corresponding name field. See ID Policy for details.

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Personal Information
First Name*
Middle Name*	No Middle Name
Last Name*
Birthdate (mm/dd/yyyy)*
Gender
Do you consider yourself to be of Hispanic origin?
Which of the following best describes your race? You may mark more than one.
Is English your first language?

Contact Information
Address*


City*
State
ZIP Code
Country*
Phone*
Email*

	Association of Schools and	ABOUT ASCO
	Colleges of Optometry	ABOUT OPTOMETRIC EDUCATION
	6110 Executive Blvd, Suite 420	For Faculty & Administrators
	Rockville, MD 20852	Partnerships & Advocacy
	Tel: (301) 231-5944	Data & Surveys
	Fax: (301) 770-1828	News &Publications
	Contact Us	Optometry Admission Test
		OptomCAS

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