NAIT Optical Sciences - How to Apply - Alberta Students
Eyeglasses Year One
Applicants must complete the Optical Sciences application form beginning on page 3 of this document and forward it to
the program office, not the Registrar's Office. The application form can be completed online and then printed; however,
you cannot apply online until you have submitted this application form to the Optical Sciences Program Office and have
been given a conditional acceptance. The Personal Information section of the application form must be typed to ensure
accuracy of this information.
1. Admission Requirements
Applicants must already be working in an optical dispensary and have someone qualified and willing to oversee their
practical training, such as a licensed optician, optometrist or ophthalmologist. A completed, witnessed Contract of
Practicum, signed by the student and the supervisor, must be submitted with your application package.
Applicants must have obtained a Canadian High School Diploma or the assessed equivalent.
If you have any questions regarding admission requirements, please contact the program office using the contact
information provided on page 2 of this document.
2. Official Transcripts
As part of the application process, applicants must provide NAIT with an original, official High School Transcript. Official
transcripts are original academic documents bearing the official seal, stamp and/or signature of the issuing institution or
agency. Please indicate on your transcript request form that the original transcript be mailed to your HOME ADDRESS and
NOT to NAIT. Please submit your original, official High School Transcript with your application package.
To order your High School Transcript please visit the website below. Click on the province you graduated from for further
instructions.
http://alis.alberta.ca/ec/ep/pps/high-school-transcripts.html
3. When to Apply
Applications for the January 2015 intake will be accepted starting October 1, 2014 until the registration deadline of
November 24, 2014. You will be notified in writing by e-mail of your acceptance during this registration period. This
intake begins January 5, 2015.
4. Tuition
Please refer to the NAIT website (www.nait.ca) for tuition fees and payment deadlines for the 2014/2015 academic year.
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NAIT Optical Sciences - How to Apply - Alberta Students
5. A complete application must include:
Eyeglasses Year One
* All necessary information on both pages of the NAIT Optical Sciences application form
* A completed, witnessed Contract of Practicum
* An original, official Canadian high school transcript or assessed equivalent
* Two passport-size colour photos (originals, not copies)
6. Where to submit a completed application package
Mailing Address
Optical Sciences
W111, HP Centre
11762 - 106 Street
Edmonton, AB T5G 2R1
Courier Address & In Person
Optical Sciences
W111, HP Centre
10504 Princess Elizabeth Avenue
Edmonton, AB T5G 3K4
Phone: 780-378-2800 or 1-888-491-3130
Fax: 780-471-8377
Please note that the January 2015 intake will only
run if there are a sufficient number of students enrolled.
Page 2
NAIT Optical Sciences Application Form - Alberta Students
Print Form
Eyeglasses Year One
Personal Information
Previous NAIT Student
No NAIT ID #
Yes
Legal First Name
Middle Name
Legal Last Name
Gender
Previous Legal Last Name
Date of Birth (mm/dd/year)
Home Address
City
Province
Postal Code
Home Phone #
Business Phone #
Cell Phone #
E-mail Address
Male
Female
Citizenship Status
Canadian Citizen
Permanent Resident
Study Permit (Student Visa)
Prerequisite
Eyeglasses Year One - Original, Official High School Transcript Attached
Yes
No
If transcript is not attached, please indicate reason: __________________________________________________________________
Preferred Exam Location
All Students - check preferred exam location
Edmonton
Calgary
DECLARATION:
I hereby declare that the information provided in the foregoing application is complete and true in all respects and I make this
solemn declaration believing it to be true and knowing that it is of the same force and effects as if made under oath by virtue of the
Canadian Evidence Act.
Date
Declarant's (Student) Signature
Witness Signature
Witness Name (printed)
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NAIT Optical Sciences Application Form - Alberta Students
Program/Course Applied For
Eyeglasses Year One
First Semester
Second Semester
Frames (OPSC1112)
Communication (OPSC1111)
Math and Optics (OPSC1113)
Prescriptions & Single Vision Lens Design (OPSC1212)
Instruments and Measurements (OPSC1211)
Analysis & Interpretation of Lenses & Prescriptions (OPSC1213)
Clinical I: Eyeglasses (OPSC1191)
Clinical II: Eyeglasses (OPSC1292)
Include with this two-page application:
1. A completed, witnessed Contract of Practicum
2. An original, official High School Transcript or assessed equivalent
3. Two passport-size, colour photos (originals, not copies)
Mailing, Courier or Drop Off Address
Mailing Address
Optical Sciences
W111, HP Centre
11762 - 106 Street
Edmonton, AB T5G 2R1
Courier Address & In Person
Optical Sciences
W111, HP Centre
10504 Princess Elizabeth Avenue
Edmonton, AB T5G 3K4
Phone: 780.378.2800 or 1.888.491.3130
Fax: 780.471.8377
Payment Options
Once you have applied through the Program Office and been given a conditional acceptance into the program, you will receive
instructions by e-mail with respect to applying through APAS (Alberta Post Secondary Application System).
Once you have completed the APAS application and been accepted by the NAIT Registrar's Office, you will receive another e-mail
from the Program Office with instructions to make payment. You will have the option of paying for one term at a time or both terms.
If you are paying by credit card, you will be able to do so on-line or by telephone. If you are paying by bank draft, money order or
cheque, you will be instructed to send it to the program office at that time.
Please check the appropriate box below for payment.
Cheque payable to NAIT (attached)
Credit Card
Student Loan
Page 4
NAIT Student ID Number
NAIT Optical Sciences - Contract of Practicum
This Agreement, dated the ________ day of _________________, 20______
Between: _______________________________________ (hereinafter called the “Supervisor”)
And __________________________________________ (hereinafter called the “Student”)
And The Northern Alberta Institute of Technology (hereinafter called “NAIT”)
The purpose of this Agreement is to define the roles and responsibilities of each of the parties in relation to the practicum component of the
Program of Study (“Program”) in which the Student is enrolled, at NAIT.
The Student is enrolled in the [choose one]:
Eyeglass Dispensing Program ______
Contact Lens Dispensing Program ______
Sight Testing Program ______
The Parties hereto agree that:
1. The Supervisor agrees to accept and train the Student in all areas of the profession so far as the Supervisor's facilities and availability of work permits.
The Supervisor further agrees to provide to NAIT and to the College of Opticians of Alberta, such information regarding the Student in relation to the
Student's progress in the practicum experience, as may be requested from time to time, by NAIT or the College of Opticians of Alberta.
2. The Supervisor agrees to accept sole responsibility for all acts of the Student while registered under his/her supervision, including consumer complaints,
unskilled practice or professional misconduct.
3. The Student of his/her own free will agrees to work with and be trained in the profession by the Supervisor for the term approved by NAIT. The Student
further agrees to provide NAIT with such information regarding the practicum experience as requested from time to time, and further, the Student hereby
consents to the sharing of his/her personal information (including attendance, work experience, behavior, attitude, employment details and other matters
impacting the Student's training and work experience), among the Supervisor, NAIT and the College of Opticians of Alberta, for purposes of evaluation of
his/her practicum experience, and this consent constitutes a consent to disclose personal information, pursuant to section 40(1)(d) of the Freedom of
Information and Protection of Privacy Act, RSA 2000, c. F-25.
4. The Supervisor and the Student agree that the Student shall be employed full-or part-time for purposes of accumulating a portion or all of the required
hours of work practicum over the period while the student is enrolled in any of the Optical Programs listed above.
5. All of the parties agree that the Student will be under direct supervision of the Supervisor and further that the Supervisor will:
a) be directly and personally involved in the work of the Student;
b) document only work hours where direct supervision is present;
c) display his/her certificate of registration on the training premises where the Student is employed; and
d) be responsible for the work of the Student at all times.
6. All parties are further agreed that they shall be subject to and shall abide by the provisions of the Act, Regulations, Standards of Practice, and Bylaws of
the College of Opticians of Alberta as they apply to eyeglass dispensing, contact lens dispensing, and sight testing.
7. It is the responsibility of the Student to update records with NAIT and the College of Opticians of Alberta within fourteen (14) days upon changes of any
details of this Agreement (with regards to changes of name, address, supervisor or employment).
8. It is the responsibility of the Supervisor to advise NAIT and the College of Opticians of Alberta within 14 days of the termination of employment of the
Student.
9. Student and Supervisor both agree to cooperate fully with a visit of a field supervisor.
10. The parties hereto agree that this Agreement shall not be nor shall it be deemed to be a contract of permanent employment between the Supervisor and
the Student and this Agreement may be terminated by either Supervisor or Student forthwith without prior notice to the other.
11. Subject to paragraph 10, this Agreement shall be effective for (a) the period that the Student is under supervision of the Supervisor for completion of 500
hours of work experience or (b) one (1) year, which ever shall first occur.
PRACTICUM SUPERVISION:
Occupation of Supervisor:
Optician ______ Optometrist _____
Ophthalmologist _____
Supervisor's Name: _________________________________
License Number: _________
Company Name: ___________________________________
Telephone: (
Address: _________________________________________
Fax: (
) ________________
) _____________________
City: ______________________ Province: _______________ Postal Code: _______________________
IN WITNESS WHEREOF the contracting parties hereto have hereunder set their hand the day and year aforesaid.
________________________
Supervisor's Signature
_______________________
Student's Signature
_____________________________
Witness Signature
_____________________________
________________________
Per: Northern Alberta Institute
of Technology
Witness Signature
Page 5
NAIT Optical Sciences - Textbook List
Course
Title & Author
ISBN No.
Eyeglasses Year One
0750674806
Eyeglasses Year One
9780937404737
Eyeglasses Year One
0750675047
All Courses
System for Ophthalmic Dispensing by Brooks/Borish, 3E 2007
Dictionary of Eye Terminology by Cassin, 6E 2011
Optical Formulas Tutorial by Stoner, 2E 2005 (Optional)
Sharp EL531GB-WH Calculator
All textbooks are available at the NAIT Bookstore on the main campus in Edmonton or on-line at www.onlinestore.nait.ca
Bookstore Phone (780) 491-3104
Updated September 2014
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