Use this form to list a practice opportunity for an optometrist. After completing the form below, select the SUBMIT button at the bottom of the page to post your profile on the Web. Submissions will remain on our placement service Website for at least 6 months; please resubmit your information at the end of 6 months if you desire to be listed on the placement site for another 6 months. To delete or edit a current listing, contact the IU School of Optometry Web Administrator at opt@indiana.edu, specifically identifying the listing to be removed or the information that is to be corrected. Be sure to include under which regions (e.g., Southern Indiana, East North Central, Pacific) you posted your listing.

Describe available position:
Employment Partnership	Associateship Practice for sale	Associateship leading to partnership
Other (specify):

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Name of practice:
Address:
City:		State/province:
Zip/postal code:		Country:
Contact person:
E-mail address:
Phone:		Fax:

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United States of America	Indiana

In which region (designated on the maps above) is your practice located?
Indiana, USA
	Northern Indiana
	Central Indiana
	Southern Indiana
United States of America
	New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)
	Middle Atlantic (New Jersey, New York, Pennsylvania)
	South Atlantic (Delaware, Florida, Georgia, Maryland, N. Carolina, S. Carolina, Virginia, W. Virginia)
	East North Central (Illinois, Michigan, Ohio, Wisconsin)
	East South Central (Alabama, Kentucky, Mississippi, Tennessee)
	West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, N. Dakota, S. Dakota)
	West South Central (Arkansas, Louisiana, Oklahoma, Texas)
	Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming)
	Pacific (Alaska, California, Hawaii, Oregon, Washington)
	Other country

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Population of area:

Description of area:

Age of practice:

Years at current location:

Type(s) of practice (check all that apply):
Private Partnership Education	Associateship Community seeking OD Health professional seeking OD	Public health Group/health maintenance Civil service
Other (specify):

Specialty area(s) of practice (check all that apply):
Primary care Contact lenses	Pediatrics Vision training	Geriatrics Low vision	Ocular disease
Other or future specialties (specify):

Date position open: (month/day/year)

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Compensation:

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Additional information about position and/or practice:

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	URL: http://www.indiana.edu/~opt/placemnt/odpos/odpos.htm Revised: December 20, 2005
	IU Optometry home page: http://www.opt.indiana.edu/ Comments: Web Administrator Copyright © 2009, The Trustees of Indiana University