Information

This form is to be completed by the resident. All NCOPE resident orthotists/prosthetists must register at least two weeks in advance of the residency program start date.  Allow up to 14 business days from the date this registration form is completed for processing by the NCOPE staff.  Upon successful processing, the resident and director of the NCOPE accredited residency program will receive formal notification by email. 

This form may be started and finished later by selecting “Save” and providing the email address of the person who is completing this form.  A personalized hyperlink will be provided to the form containing the information already provided. 

Section 1 - Resident Contact, Demographic and Education Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Primary Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Is the resident a United States citizen? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Please identify the education insitution that the resident graduated from with a minimum of a master's degree in orthotics and prosthetics.

{ binding firstError.message }

Please enter the graduation date (conferral date) as shown on the transcript. 

Official Transcripts Submission {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

An OFFICIAL TRANSCRIPT is required. Submit official transcript from the graduate degree program in orthotics/prosthetics sent directly from the education institution to our office by mail or email to info@ncope.org

Mailing address for transcripts - 330 John Caryle St., Ste. 200, Alexandria, VA 22314 Attn: Residency Program Services. 

 Transcripts must be received within the first 30 days of starting a residency program.  Delay of receiving may delay the end date for residency completion.

Prior Conviction(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Have you ever been convicted by a court of competent jurisdiction or pleaded nolo contendere to a felony or any crime(s) involving moral turpitude, or are they now under current indictment(s) for such a crime?

{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }

A signed written statement must be generated providing a full explanation of the crime or indictment identified in the previous question.  This document should be scanned into PDF format and submitted on the final page of this form.  

Section 2 - Resident's Residency Program Information

This section relates to information specific to the resident and the program type they are registering to attend.

Registration Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }

To run the resident status report, please visit: http://residents.ncope.org/eweb/DynamicPage.aspx?WebCode=LoginRequired&expires=yes&Site=ncope

First or Second Residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

A second residency is defined as a single discipline orthotic OR prosthetic residency being completed AFTER a separate single discipline residency has already been completed in the opposite discipline.

Have you received your certificate of completion from Accredible/Credential.net for your first residency?   {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

It is best to register for your second residency once you successfully complete the first residency.  Failure to successfully complete the first residency including submission or all required documentation within 30 days of the first residency end-date may result in a delay in you second residency start date or the need to submit this form again. 

{ binding firstError.message }
Have You Received Formal Notification From the NCOPE Staff that the First Residency Has Been Officially Marked Complete? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

You have identified that this registration is for your 2nd residency.  When completing the questions below, please enter the program type/track, start date, and duration for the 2nd residency.

Residency Discipline(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Residency Track {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Reference NCOPE Residency Standards. Specifically Standard II: Residency Requirements, 2.6.2 for the two tracks. 

{ binding firstError.message }

Residency start date must be after the date that the degree O&P was awarded.

Program Duration in Months {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Did you use OPRESCAS to apply to this residency position? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

The Orthotics and Prosthetics Residency Centralized Application Service (OPRESCAS) is an application service that is required for all residency programs, except Hanger Clinic.  Reference NCOPE Residency Standards. Standard III: Administration and Resources of the Residency Program, 3.2.6

Residency Term {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Reference NCOPE Residency Standards,  Standard II: Residency Requirements, 2. 1.

Residency may be completed part-time, which is considered greater than or equal to 20 hours but less than 37.50 hours a week. However, the residency program must be completed within 36 months for a combined O&P program and 24  months for a single discipline program.

Graduate Placement Notification {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

The faculty of your educational program are required to document graduate placement data and would benefit from knowing that you have secured a residency position.  If you grant permission, NCOPE will share your name, email, residency program, type, start date and residency director name/email.

American Academy of Orthotists and Prosthetists Permission {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

The American Academy of Orthotists and Prosthetists (the Academy) is dedicated to the success of practitioners of all levels and would like to connect with resident practitioners such as yourself.  If you grant permission, NCOPE will share your name, email, residency program and discipline with the Academy.

{ binding firstError.message }
Section 3 - Residency Program Site Information

This section provides contact information and details concerning the residency site.

{ binding firstError.message }
{ binding firstError.message }

The residency site ID can be found on the residency program directory.  It consists of 9 number followed by a capital letter "O"

Click HERE to view the Residency program directory: https://ncope.org/index.php/home-page-v2/residency-and-professional-experiences/residency-program-directory/

Address of Residency Program {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Please identify the physical location where the resident will be located primarily for their residency.

{ binding firstError.message }
{ binding firstError.message }
Is the residency program in a state where orthotists, prosthetists, and/or residents are regulated via licensing laws or registration with a state licensing board? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

For a comprehensive list of states where the O&P profession is regulated in this manner, please visit ABC's State Licensure Toolkit.  This link is external to the NCOPE website and will open in a new tab/page.

{ binding firstError.message }

Please assure that you are registering to a residency program that is already accredited. Reference the NCOPE Accredited Residency Programs listing on-line and enter the Accreditation End Date.  If you cannot find the residency program listed, please contact residency@ncope.org.

{ binding firstError.message }
{ binding firstError.message }

Section 4 - NCOPE Tracker Details

NCOPE Tracker is a custom application m to capture clinical experiences of residents and to complete documentation tied to the NCOPE Residency Program.  Reference NCOPE Residency Standards. Standard V: Residents 5.3 and required documentation.

Residency Director {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

For a list of all residency faculty members at an accredited site, please visit the NCOPE Residency Faculty Directory by Clicking HERE.

Director Credentials {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

If the director is both certified AND licensed, please select the certification held and not "State Licensed"

{ binding firstError.message }

This will be the email address they use to access NCOPE Tracker.

Director Training {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Please verify with your director their completion of the Online Residency Development Courses (or ACM). Reference NCOPE Residency Standards. Standard IV: Faculty,Roles and Responsibilities, 4.1.4. and 4.2.4.

Electronic Medical Record (EMR) Platform {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Please identify the EMR platform that is used at the residency program you are attending.

{ binding firstError.message }

Verify the email you wish for NCOPE to use to access our online systems.  This will be the email address used to login into NCOPE Tracker and other tools such as the NCOPE Resident Status Report

{ binding firstError.message }

Section 5 - Payment Information

Who is paying the resident registration fee? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Form of Payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Here are the current NCOPE Resident Registration Fees.

Will You be Submitting an Online Payment Today? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

Make checks payable to NCOPE and include the resident's name, company name and address on the memo line.  

Payment Address: 330 John Carlyle Street, Suite 200  –  Alexandria, VA 22314

Click HERE to make a payment using the NCOPE residency payment portal.  The link will open in a new tab/window in your browser.   

{ binding firstError.message }
{ binding firstError.message }

Section 6 - Attestation/Confirmation

Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }

By selecting "Agree", you acknowledge that you have reviewed and are familar with the NCOPE Residency Standards including all requirements defined in Standard V: Residents.

True, Complete and Accurate Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Information

Section 1 - Resident Contact, Demographic and Education Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Primary Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Work Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Primary Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Secondary Email  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Is the resident a United States citizen? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
 Last Four Digits of Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sex  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Race/Ethnicity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
O&P Academic Program Institution {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Graduation Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Official Transcripts Submission {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Prior Conviction(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If yes, please upload a written statement of explanation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Section 2 - Resident's Residency Program Information
Registration Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{binding EnterTheNameOfTheResidencySiteWhereParentSectionNameFirstBeganTheirResidency_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Enter the final day that the residency program took place prior to being placed on-hold {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Provide a copy of the current resident status report to identify documentation on file with the NCOPE staff {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
First or Second Residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you received your certificate of completion from Accredible/Credential.net for your first residency?   {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

It is best to register for your second residency once you successfully complete the first residency.  Failure to successfully complete the first residency including submission or all required documentation within 30 days of the first residency end-date may result in a delay in you second residency start date or the need to submit this form again. 

Enter the Date of Completion for the First Residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have You Received Formal Notification From the NCOPE Staff that the First Residency Has Been Officially Marked Complete? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

You have identified that this registration is for your 2nd residency.  When completing the questions below, please enter the program type/track, start date, and duration for the 2nd residency.

Residency Discipline(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Track {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Start date of residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Program Duration in Months {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Did you use OPRESCAS to apply to this residency position? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Term {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Graduate Placement Notification {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
American Academy of Orthotists and Prosthetists Permission {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Section 3 - Residency Program Site Information
Residency Program Name (Organization) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Site-ID {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address of Residency Program {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone Number of Residency Site {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Fax Number  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Is the residency program in a state where orthotists, prosthetists, and/or residents are regulated via licensing laws or registration with a state licensing board? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Program Accreditation - End Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Section 4 - NCOPE Tracker Details

Residency Director {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Director Credentials {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Director Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Director Training {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Electronic Medical Record (EMR) Platform {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Resident Email - Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Section 5 - Payment Information

Who is paying the resident registration fee? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Form of Payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Will You be Submitting an Online Payment Today? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Make checks payable to NCOPE and include the resident's name, company name and address on the memo line.  

Payment Address: 330 John Carlyle Street, Suite 200  –  Alexandria, VA 22314

Click HERE to make a payment using the NCOPE residency payment portal.  The link will open in a new tab/window in your browser.   

{ binding firstError.message }
{ binding firstError.message }

Section 6 - Attestation/Confirmation

Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
True, Complete and Accurate Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
The email has been sent.

Your progress has been saved.

{ binding firstError.message }

Information

Section 1 - Resident Contact, Demographic and Education Information

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Primary Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Work Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Mobile Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Primary Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Secondary Email  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Is the resident a United States citizen? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
 Last Four Digits of Social Security Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Sex  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Race/Ethnicity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
O&P Academic Program Institution {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Graduation Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Official Transcripts Submission {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Prior Conviction(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
If yes, please upload a written statement of explanation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
Section 2 - Resident's Residency Program Information
Registration Type {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{binding EnterTheNameOfTheResidencySiteWhereParentSectionNameFirstBeganTheirResidency_Label, source = {{ $context.parentContext.dataItem }} } {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Enter the final day that the residency program took place prior to being placed on-hold {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Provide a copy of the current resident status report to identify documentation on file with the NCOPE staff {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources['fileupload-dropzone-message'] }}
{binding Name, mode=oneTime}
{binding Description}
{ binding firstError.message }
First or Second Residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have you received your certificate of completion from Accredible/Credential.net for your first residency?   {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

It is best to register for your second residency once you successfully complete the first residency.  Failure to successfully complete the first residency including submission or all required documentation within 30 days of the first residency end-date may result in a delay in you second residency start date or the need to submit this form again. 

Enter the Date of Completion for the First Residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Have You Received Formal Notification From the NCOPE Staff that the First Residency Has Been Officially Marked Complete? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

You have identified that this registration is for your 2nd residency.  When completing the questions below, please enter the program type/track, start date, and duration for the 2nd residency.

Residency Discipline(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Track {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Start date of residency {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Program Duration in Months {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Did you use OPRESCAS to apply to this residency position? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Term {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Graduate Placement Notification {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
American Academy of Orthotists and Prosthetists Permission {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
Section 3 - Residency Program Site Information
Residency Program Name (Organization) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Site-ID {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address of Residency Program {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone Number of Residency Site {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Fax Number  {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Is the residency program in a state where orthotists, prosthetists, and/or residents are regulated via licensing laws or registration with a state licensing board? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Residency Program Accreditation - End Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }

Section 4 - NCOPE Tracker Details

Residency Director {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Director Credentials {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Director Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Director Training {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Electronic Medical Record (EMR) Platform {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Resident Email - Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }

Section 5 - Payment Information

Who is paying the resident registration fee? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Form of Payment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Will You be Submitting an Online Payment Today? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Make checks payable to NCOPE and include the resident's name, company name and address on the memo line.  

Payment Address: 330 John Carlyle Street, Suite 200  –  Alexandria, VA 22314

Click HERE to make a payment using the NCOPE residency payment portal.  The link will open in a new tab/window in your browser.   

{ binding firstError.message }
{ binding firstError.message }

Section 6 - Attestation/Confirmation

Acknowledgement {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
True, Complete and Accurate Confirmation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
{ binding firstError.message }