Use this form if you are an optician/technician student or graduate 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 placement 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:
Best time to contact you:

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Do you have an Optician/Technician A.S. degree?	Yes No
Are you a graduate of the IU School of Optometry Optician/Technician Program?	Yes No
Did you complete the Optician's Lab Concentration?	Yes No
If you are a current student in the IU School of Optometry Optician/Technician Program, in what year of the program are you enrolled?	1st year 2nd year
Years experience in optometric/optical/ophthalmic fields:
Are you seeking full-time or part-time employment?	Full-time Part-time Either full- or part-time
Additional information (experience, type of position desired, etc.):

United States of America	Indiana

In which of the regions designated on the maps above do you wish to work? 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/techprf/techprf.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