Certification Exam Application Form Name* First Middle Last Email* * As part of the application process, please login to your member profile and ensure that all of your contact and employment information is current and up to date. This information will be used to contact you regarding important exam informationDiscipline*OrthoticsProstheticsExam Session*FallWinterPlease indicate which exam you are applying for*Orthotic Certification Written ExaminationOrthotic Certification Practical ExaminationProsthetic Certification Written ExaminationProsthetic Certification Practical ExaminationOrthotic Registration ExaminationProsthetic Registration ExaminationHave you previously sat at an OPC Examination in the discipline you are applying for?*YesNoIf yes, provide the yearsAre you applying for accomodation of a physical or learning disability?*YesNoPlease Describe:Are you registering a medically necessary electronic divice?*YesNoPlease Describe:Adherence to GuidelinesPrimary Supervisor Name: First Last Email Secondary Supervisor Name: First Last Email Certificate Name Designation FormName to Appear on Certificate: First Middle Last Certificate Language*EnglishFrenchName Confirmation:* I confirm that the information is accurate I have read and have ahdered to the guidelines laid out in the OPC Candidate Declaration.* Agree Please note, your acceptance to sit any Examination is conditional on OPC receiving the appropriate Examination Fees on or before the Examination Fee Deadline. Exam Fees & Exam Application Fees are available through the OPC Store. The complete application and non-refundable application fee must be received by the OPC National Office no later than the specified dates. Incomplete or late applications will not be processed. Submit This iframe contains the logic required to handle Ajax powered Gravity Forms.