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Application For Residency Program


Fields marked with * are required.

For which program are you applying? *

Contact Lens

Pediatrics / Binocular Vision

First Name *
Last Name *
Other name under which records may be found
E-mail Address *

Mailing Address *
City *
State / Province *

If other, enter State and Country.

Zip *
Telephone *
Permanent Address? *

Same as Mailing Address?

Yes No

Address                     City                                          State/Province                         Country                                  
Zip                                                    Telephone            

Are you a citizen of the United States? *

Yes No

If No, which Country ?

Date of Birth * [mm/dd/yyyy]
Received / Will receive O.D. degree *

If other, which?
Date degree received / will receive * [mm/dd/yyyy]
NOTE: Providing the information mentioned below is optional and is requested for purposes of reporting to Federal Compliance Agencies only and will be removed by the university before your application is processed. It will not be used in determining admission status.
Sex: Male Female

Ethnic Origin:

White, non-hispanic Asian or Pacific Islander Hispanic

Black, non-hispanic American Indian or Alaskan Native Non-resident Alien

Please take required actions for the following documents or email them to Maria Ahrens,
Administrative Assistant

  • Request your official optometric transcripts be sent to the College of Optometry.
    (It is necessary for you to request updated official transcripts as coursework is completed).
  • Three (3) letters of recommendation from faculty at the School or College of Optometry from which you graduated or will graduate. A minimum of one faculty letter should be from someone involved in the appropriate specialty.
  • A Curriculum Vitae is also required.

I certify that the information contained in this application is true to the best of my knowledge. I understand that information related to my admission status at the University of Missouri-St. Louis College of Optometry will be submitted to the Association of Schools and Colleges of Optometry for statistical purposes. In accordance with Missouri law, all UM-St. Louis faculty and residents are subject to a criminal background check.

All application material should be addressed to: Maria Ahrens, Administrative Assistant for Residencies, University of Missouri-St. Louis, College of Optometry, One University Boulevard, St. Louis, MO 63121-4400.

Webmasters: Dr. Ralph Garzia & Manasee Punjani