NAIOMT > Intermediate and Advanced Registration Info Request

NAIOMT Level III, IV Course Registration Request


	Please read the NAIOMT Privacy Policy.

Detailed instructions and passwords will be sent to candidates and proctors a week before the exam.

Please note: online registration is a two step process.
1) Click a link below to provide us your information and select exam to register for. When you have submitted this information, you will be provided a link to pay for the exam registration.
2) Pay for your exam registration.
Exam registration is not complete until payment is received!

Student Info

*NAIOMT ID:
	Your NAIOMT ID is your first and last initial and the last 4 digits of your social security number. For example Jane Doe whose SSN is 123-45-6789 would have a NAIOMT ID of jd6789
*Name:
Different last name (eg. Maiden):
Name desired on certificate, if applicable (name only, no designations):

PT Info

*PT License #:
*PT License Exp Date:
*PT License State:
*I hereby certify the PT license and information I have provided is true and accurate:

Contact Info

	Home / Personal	Employer Name:
*Address:		Work Address:
Add, line 2:		Work Add, 2:
*City:		Work City:
*State:		Work State:
*ZIP:		Work Zip:
Country:		Work Country:

*Phone: (xxx) xxx - xxxx		Work Phone: (xxx) xxx - xxxx
*Email:		Work Email:
Fax:		Work Fax:
Email Preference:	Home Work

Training Info

*University / College Name :
*State:
*Country:
*Year of PT graduation:
*Degree earned:
Andrews Student?
Andrews students must have Andrews University submit an official transcript to NAIOMT. Andrews students taking the Level III Oral Practical Exam are responsible for a $665 administrative fee to cover the costs associated with certification. Contact Kathy Berglund with Andrews University or the NAIOMT Exam Coordinator with questions.

NAIOMT Coursework / Exam Info

Course Name:	Course Taken	Course Challenged
500 Level I Differential DX
600 Level II Upper Quadrant
610 Level II Lower Quadrant
700 Level III Upper Quadrant
710 Level III Lower Quadrant
800 Level IV Adv. Techniques

Exam Name:	Year:	Exam Completed
Level I Online Exam
Level II LQ Exam
Level II UQ Exam
Level III Written Exam
Level III Case Histories Exam
Level III Oral Practical Exam

Challenging Course Policies:
If you are pursuing examination and plan not to attend certain NAIOMT core courses you are required to pay a one-time $15.00 per day per course fee ($90.00 - Core courses run 6 days) for all related courses not attended at the time you register for the exam. Follow the above directions for "Follow-Up Payments".

Register for Level III Written Exam

Level III
-$330
-$100 late fee

Not signing up for this exam

Oct 2, 2010

Mar 5, 2011

Oct 1, 2011

Level III Written Exam Proctor Information


*Proctor Name:
Proctor Relationship: Your proctor may not be a spouse, relative, or roommate.*
*Proctor Business Name:
*Proctor Address:
*Proctor Phone:
*Proctor FAX:
*Proctor Email:

The proctor must have an individual email and mailing address separate from the candidate/s (mailing address may be the same if both are located in the same office). Both the candidate and their proctor are responsible for checking their email on a regular basis prior to the examination date as most communications from the exam coordinator prior to the exam will be via email. Candidates and proctors will be emailed or mailed confidential instructions sometime during the week prior to the examination date. NAIOMT now has a study guide with sample examination questions. Email requests for a copy of this guide to exams@naiomt.com . More proctor information can be found on the Online Exam FAQ page here.

Register for Level III Case Histories

Level III
-$200 initial or $67 for each retake
-$100 late fee if applicable

Not signing up for this exam

Oct 2, 2010

Mar 5, 2011

Oct 1, 2011

Register for Level III or Level IV Oral Practical

Select level:

Level III

Level IV

-$1000
-$100 late fee

-Andrews Admin fee if applicable, $665

Select date:

Not signing up for this exam

Nov 11, 2010 - Berrien Springs, MI

Nov 12, 2010 - Berrien Springs, MI *Exam full

Nov 13, 2010 - Omaha, NE *Exam full

Nov 14, 2010 - Omaha, NE

Dec 11, 2010 - Portland, OR

Dec 12, 2010 - Portland, OR

Mar 3, 2011 - Dallas, TX

Apr 11, 2011 - Seattle, WA *Level 3 only.

Jul 9, 2011 - Portland, OR

Nov 3, 2011 - Berrien Springs, MI

Nov 4, 2011 - Berrien Springs, MI

Dec 10, 2011 - Portland, OR

LIII and LIV Oral Practical Date Change and Cancellation Policy

Date Change Policy for LIII and LIV Oral Practical Exams:
An exam candidate may request a date change for their exam up to 12 weeks prior to the exam date for an additional $50. Please follow the above exam date change follow up payment directions.

Cancellation Policy for LIII and LIV Oral Practical Exams:
If you are not able to pay the full application fee at the time of submitting your application, you may submit a $500 NON-REFUNDABLE DEPOSIT with your application. The balance of the exam is due 12 weeks prior to the exam date or the candidate risks forfeiture of their deposit and time slot.

Twelve Weeks Prior to the Exam Date:
1.) Cancellation on or after the 12-week deadline will result in the loss of the deposit ($500). If another exam candidate can be found to substitute (up to 8 weeks prior to the exam) the $500 deposit will not be lost, but will be applied to another exam date. A $50 exam date change fee is applied.

2.) If an exam candidate chooses to entirely cancel their entry to exam (opting out of a date change) NAIOMT retains the deposit of $500.

Eight Weeks Prior to the Exam Date:
1.) Within 8 weeks of the exam there is no option to find a
substitute exam candidate and total fees for the exam will be forfeited.

2.) Exam Candidate illness or emergency. NAIOMT will consider each emergency situation on a case by case basis. The registration fees paid may be applied to a future exam date. A date change fee of $50 is applied. If an exam candidate chooses not to reschedule the exam they forfeit all exam fees paid at that point.

Cancellation may jeopardize the running of the exam. NAIOMT reserves the right to cancel oral practical exams due to lack of registrants. NAIOMT will make every effort to give at least an 8 week notice if an exam needs to be cancelled or a date change needs to take place.

When NAIOMT cancels or makes a date change, there is no financial penalty to the candidate. NAIOMT will endeavor to transfer the candidate to another exam site or date as close as possible to the original arrangements. NAIOMT will not be responsible for any costs involved in changing travel plans. The candidate is advised to wait to make travel plans until after the 8 weeks pre-exam date, when changes are less likely.

Contact the exam coordinator for further assistance and information at, 1-800-706-5550 or at, exams@naiomt.com.

With the following electronic affirmation and date to verify I agree:

I wish to apply for the examination(s) indicated above and if applicable have included the fee(s) for courses I am not taking. I understand I may choose level III exam components for different dates, but that the application deadlines for each part must be honored. Re-examinations for failed components are at 100% of the original fee and there are no academic appeals. Postponement of exams due to health reasons must be accompanied by a note from a physician and remains at the discretion of the exam coordinator. I hereby certify the information I have provided is true and accurate and I am a currently licensed physical therapist in good standing.

*Agreed

*Date