Ontario Prescribing & Therapeutics Examination Preregistration Form (Non-Registrants)

Ontario Prescribing & Therapeutics Examination Preregistration Form (Non-Registrants)

This form is required for Naturopathic Doctors who are not registered with the College of Naturopaths of Ontario and by 4th year students in a CNME-accredited program, in order to set-up a College user account to facilitate exam registration for the Ontario Prescribing and Therapeutics exam.

Please ensure that you meet exam eligibility criteria, as noted in the Ontario Prescribing and Therapeutics Examination Handbook, before submitting documentation to the College.

CONTACT INFORMATION

First Name*

Please provide your given (first) name.

Last Name*

Please provide your family (last) name.

Email*

Please provide an email address to which the College may send you communication or information.

Telephone*

Please provide a telephone number where the College can reach you during regular business hours. To adjust the country, please use the arrow key to select the correct flag.

Phone

Street Number and Name*

Please provide your street number and street name, or postal box number for your mailing address. If you live in a multi-unit building, please enter the unit number in front of the street number. For example, 601-2222 Any Street is unit 601, at the building located at 2222 on "Any Street".

City, Town or Community*

Please provide the city, town or community for your address.

Province or Territory*

Please select the Province or Territory for your mailing address.

Ontario

Postal Code

Please provide the postal code for your mailing address.

CONFIRMATION OF IDENTITY

Government ID*

All Exam Pre-registration forms must include a copy of valid (not expired) government issued photo identification, clearly showing full name, date of birth, face and signature. Only the identification listed below is accepted by the College at this time. Please indicate which identification you are providing.

Please note: ID used must have a photo and your signature. The Secure Certificate of Indian Status Card must have been issued on or after December 15, 2009.

Supporting Documents*

Please upload a copy of the photo identification that you listed above.

Drag and drop files here or

CONFIRMATION OF ELIGIBILITY

Exam Registration Eligibility*

Please select one of the two options that best describes your current status.

I am a 4th year student in a CNME-accredited program.

I am current registered to practise in another regulated Canadian jurisdiction.

Graduation Date

Please enter the date that you will graduate from the CNME program you are attending.

CNME Program

Bastyr University (Kenmore)

Bastyr University (San Diego)

CCNM - Toronto Campus (Toronto)

CCNM - Boucher Campus (Westminster)

National University of Health Sciences (Lombard)

National University of Natural Medicine (Portland)

Southwest College (Tempe)

Universidad Ana G. Ménde (Puerto Rico)

Regulatory Authority*

Please select the name of the Regulatory Authority in the Canadian province in which you are registered as a Naturopathic Doctor.

College of Naturopathic Doctors of Alberta

College of Naturopathic Physicians of British Columbia

Manitoba Naturopathic Association

Saskatchewan Association of Naturopathic Practitioners

Registration Number*

Please enter your registration number with the Regulatory Authority you identified above.

DECLARATIONS AND SIGNATURE

Exam Registration Eligibility Declaration*

I declare that I am currently registered to practise naturopathy in a Canadian jurisdiction other than Ontario and that I am in good standing with the Regulatory Authority in that jurisdiction.

I agree

I do not agree

Exam Registration Eligibility Declaration*

I declare that I am currently enrolled in the CNME-accredited program in my fourth year of education and that I expect to graduate on the date noted above.

I agree

I do not agree

Truthful & Complete Declaration*

I declare the contents of this application are true and complete to the best of my knowledge and belief. I understand and agree that if I make a false or misleading statement or representation on this form, the College reserves the right to deny my exam registration for the Ontario Intravenous Infusion Therapy examination.

I agree

I do not agree

Signature

By checking the box below, you are affixing a signature to this form and indicating that this form and the information contained herein is bound directly to you.

I voluntarily sign this form and affix my digital signature.*

Pre-registration Date*

Please enter the date you are submitting your pre-registration for the OPTE.

COPY OF SUBMISSION

Below is a check box to enable you to receive a copy of your submission. It is highly recommended that you check this box and enter your e-mail address. This will enable the on-line system to send you a copy of the information that you have provided to the College.

Send me a copy of my responses

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