Application for Apprentice Ophthalmic Dispenser License

Required Documents

Please make sure you have copies of the following required documents available for upload before proceeding:

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Personal Information

Mailing Address:

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Previous License History :

Have you previously held a Nevada Apprentice Ophthalmic Dispenser License?*
Please provide the dates of your apprenticeship:
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Employment Information

“Please select your workplace from the auto-generated list to auto-populate required fields. Fields cannot be left blank.”

Supervisor Information

IMPORTANT: Per NRS 637.125(3), an apprentice may only dispense when a licensed supervisor is present. You must submit an Apprentice Supervision Form, signed by your primary supervisor, along with this application. If there is a change of supervision, both you and your primary supervisor are responsible for submitting a new supervision form to the board office within ten (10) days of the change.

If supervisor holds a limited license (spectacle dispensing only), write "L" after license number. A limited licensee MAY NOT supervise the dispensing of contact lenses.
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Screening Questions

1. Are you a veteran or service member? For purposes of this application, a veteran is defined as a person meeting one or more of the following qualifications (this information is collected per NRS 417.0194):*
2. Are you subject to a court order that requires you to pay for the support of one or more children? This information is collected per NRS 425.520*
(a.) Are you in compliance with that order?*
3. Do you have a Nevada business license? (This question pertains to a license to own/operate a business, not to your occupational license to practice; this information is collected per NRS 353C.1965):*
4. Have you ever had disciplinary action taken against your occupational or professional license or privilege to practice, or certification/registration of any kind (other than your driver's license or vehicle registration) or surrendered a professional license in any jurisdiction?*
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5. Have you ever had a criminal conviction (other than a minor traffic violation), whether misdemeanor or felony, or a civil judgment rendered against you in any jurisdiction?*
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Affirmation

I affirm under penalty of perjury that all representations I have made in this application are true and complete in every respect. I hereby authorize the Nevada Board of Dispensing Opticians to make any inquiries it deems necessary to verify the accuracy and completeness of all representations I have made as part of my application.

*Your signature affirms you have reviewed, understand, and will fully comply with the provisions of Chapter 637 of the Nevada Revised Statutes (NRS) and Nevada Administrative Code (NAC) that govern the practice of an apprentice optician (these laws and regulations are available on the Board’s website: www.nvbdo.nv.gov).

**Per Nevada Open Meeting Law provision: NRS 241.033(l)(a) and (b), if the board sees cause to review your application at a public meeting, you must receive notice of the time and place. The notice must be served to you in person at least five (5) working days prior to the meeting date, or via certified mail at least twenty-one (21) working days prior to the meeting date.By signing this application, you agree to waive your legal right to such notice, and to allow the board to review any and all portions of this application at its next regularly scheduled board meeting.

Fee Details

The application for apprentice fee is NOT REFUNDABLE. Please ensure the accuracy of your information.

Description
License Period from 02/01/2023 to 01/31/2024
Fee Type
License Application Fee
Fee
$100.00