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LOMA Application

Name:
*
Location/General Office:
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Department:
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Email:
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Phone #:
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Date of Birth(mm/dd/yr):
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1. Please select a window (current or next quarter) that you wish to enroll for:
Jan – Mar
Apr – Jun
Jul – Sept
Oct – Dec

Please schedule your exam with a proctor at your location approximately 30 days in advance.

2. Please select the COURSE you wish to enroll for:

AAPA 273
AAPA 283
AAPA 303
AAPA 313
AAPA 273
AAPA 283
AAPA 303
AAPA 313
AAPA 273
AAPA 283
AAPA 303
AAPA 313
AAPA 323
ACS 100
ARA 440
LOMA 280
LOMA 286
LOMA 290
LOMA 301
LOMA 305
LOMA 307
LOMA 311
LOMA 320
LOMA 326
LOMA 335
LOMA 357
LOMA 361
LOMA 371
LOMA 380
UND 386

3. If applicable, please circle the non-proctored online course:

You do not have to select a quarter for the non-proctored online courses.

ACS 101
AIRC 411
AIRC 421
LOMA 281
LOMA 291
SRI 111

For more information on LOMA courses and designations, please visit: www.loma.org.

If you enroll in a course and fail or do not complete the course, the examination fee will be deducted from your paycheck.

Please refer to the LOMA website for the current list of examination fees.

I agree to Terms & Conditions*:
It is my responsibility to ensure that I am studying from the correct materials. I have checked the LOMA site for the current materials.

If I enroll for a course and fail or do not complete the examination, I authorize New York Life to deduct the examination fee from my paycheck. I accept full responsibility for any materials related to the above course(s) and agree to return them promptly on the examination date. I agree not to make notes or marks in the books. I further understand that if I deface the materials or fail to return them at the conclusion of the course, I am responsible for paying the full course of their replacement. I further authorize New York Life to deduct from my paycheck the full cost of any books that I deface or fail to return.