Use this form if you are an optometry student or an O.D. seeking employment. 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 placem ent service Website for 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.

Name:
E-mail address:
Current address:
Current phone:
Permanent address:
Permanent phone:
Month/year available:
School/College of Optometry:	(please select name of school/college) Indiana University School of Optometry Illinois College of Optometry Inter American University of Puerto Rico School of Optometry Michigan College of Optometry at Ferris State University New England College of Optometry Northeastern State University College of Optometry Nova Southeastern University College of Optometry The Ohio State University College of Optometry Pacific University College of Optometry Pennsylvania College of Optometry Southern California College of Optometry Southern College of Optometry SUNY State College of Optometry University of Alabama at Birmingham School of Optometry University of California, Berkeley School of Optometry University of Houston College of Optometry University of Missouri--St. Louis School of Optometry University of Montreal School of Optometry University of Waterloo School of Optometry Other
List other degrees or awards:

Position desired:
Employment Partnership Education	Associateship Practice for sale Public health	Associateship leading to partnership Group/health maintenance Civil service
Other (specify):

Specialty interests:
Primary care Contact lenses	Pediatrics Vision training	Geriatrics Low vision	Ocular disease
Other (specify):

United States of America	Indiana

In which of the regions designated on the maps above do you wish to practice? Check all that apply.
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 countries
List specific areas (states, cities, other countries, etc.) where you wish to practice:

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	URL: http://www.indiana.edu/~opt/placemnt/odprf/odprf.htm Revised: April 20, 2005
	IU Optometry home page: http://www.opt.indiana.edu/ Comments: Web Administrator Original page design and coding: Terri Greene Copyright © 2001, The Trustees of Indiana University