College of Optometry
Application for
Master of Science in Vision Science
Degree Program
OD TRACK APPLICATION FORM
2015-16 OD/MS Application 11/4/2015
PACIFIC UNIVERSITY
COLLEGE OF OPTOMETRY
MASTER OF SCIENCE IN VISION SCIENCE
OD APPLICANT
INSTRUCTIONS AND PROCEDURES
Applications Accepted:
Application Deadline:
September 8, 2015
December 1, 2015 (class of 2018), March 15, 2016 (class of 2019)
Thank you for your interest in Pacific University College of Optometry. Please submit this application if you wish to enroll in the
Master of Science in Vision Science degree program in the College of Optometry. The Master of Science in Vision Science degree
program requires that applicants have a bachelor's degree (or equivalent).
The accuracy, completeness, and neatness of your application are determining factors in the admission decision. Failure to submit a
complete or accurate application may result in disqualification for admission. The Master of Science in Vision Science Admissions
Committee will not evaluate an incomplete application. All completed applications will be reviewed together after the deadline of
December 1, 2015 (2nd year optometry students) and March 15, 2016 (1st year).
Application Checklist:
 Application Form - Type or print clearly all information requested on the optometry application forms. Your signature is required
to validate the information you provide.
 Curriculum Vita (C.V.) or Resume – Please include a detailed curriculum vita (C.V.) or resume.
 Personal Statement
 The statement should help us understand who you are, what motivates you, and what you hope to gain from a MS degree.
 You should explain why you choose to apply to the Master of Science in Vision Science graduate program in Pacific
University, your academic and career objectives. Include also a description of your current research interests -- be as specific
as you can. Describe also the faculty members whom you would like to work with if the information is available, and any
research projects you may have participated in and any other training/experience you have that are applicable to this degree.
 Two Letters of Recommendation
 Obtain two letters of recommendation from a college faculty member, an optometrist, ophthalmologist, scientist or researcher
who knows you well and can comment objectively about your qualifications.
 The letter can be sent by surface mail or by email. For delivery through surface mail: Provide a self-addressed, stamped
envelope to each individual providing a recommendation. Ask each recommender to enclose the letter of recommendation in
the envelope, sign it across the seal, and return the envelope to you. Include these envelopes, with the seals unbroken and the
signatures intact, with your application materials. Alternatively, the recommender may send his/her letter directly to Dr. YuChi Tai as email attachment to ytai@pacificu.edu. Make sure the letter contains his/her signature.
 Please be sure the letters to be received by the application deadline. We encourage you to begin the process of gathering
letters of recommendation early.
Application fee for current graduate or OD students are waived.
SEND COMPLETED APPLICATION AND ALL MATERIALS TO:
Pacific University College of Optometry
Attn: Lisette Romig
2043 College Way
Forest Grove, OR 97116
2015-16 OD/MS Application 11/4/2015
PACIFIC UNIVERSITY
COLLEGE OF OPTOMETRY
MASTER OF SCIENCE IN VISION SCIENCE
OD/MS Program
APPLICATION FOR ADMISSION
Type or print clearly in black or blue ink.
NAME
Last
First
Middle
Preferred Name
Member of Optometry Class of ________________________________
Names that may appear on transcripts (if different)
Current address (Until date:
)
Street
City
(
)
International calling code, if applicable
State
Apartment Number
Zip Code/Postal Code
(
)
Home Phone with area code
Country
(
)
Cell Phone with area code
E-Mail address:
Permanent address
Street
City
(
)
International calling code, if applicable
State
(
)
Home Phone with area code
Alternative E-Mail address:
Bachelor’s Degree Information
 B.A.  B.S. or  Other:
Date received ________________________ Major
College/University
Other Degree Information
 M.A.  M.S.  M.D.  Ph.D. or  Other:
Date received/To Be Received: ________________________ Program of study
College/University
2015-16 OD/MS Application 11/4/2015
Apartment Number
Zip Code/Postal Code
(
)
Cell Phone with area code
Country
REFERENCES
List the name and address of each individual from whom you have requested a letter of recommendation. Letters must be from an
optometrist, ophthalmologist, faculty member, or scientist.
Reference Type
Name
Complete Address/email/phone number
Occupation
Reference 1
Reference 2
CURRICULUM VITAE OR RESUME
Please attach a resume that lists employment, from the present dating back to the time you entered college (or the last 10 years). Also
include research experience, and the principal activities (college or community) in which you have participated. Please indicate any
leadership positions help. In addition, list awards, honors or scholarships received.
ESSAY
All applicants: Type a response to the essay question on a separate sheet of paper. Make sure your name is on every page,
and each page is numbered. Your essay is an important part of your application. It should be clear, concise, and well-crafted.
SIGNATURE
This College subscribes to the ethics and moral code that characterize professionalism and feels that academic honesty is fundamental
to the intellectual enterprise. Professional conduct, including academic honesty, is the expectation of all students. When a student
applies for admission, the student agrees to these principles. I understand that this application becomes the property of Pacific
University and is not returnable. I further understand that the application is accessible to faculty, staff, and members of the Master of
Science in Clinical Optometry Admissions Committee.
I affirm that all the information contained in my application is factually correct and honestly presented. I have read and understand
all application instructions and the Application Checklist.
Signature
2015-16 OD/MS Application 11/4/2015
Date_________________