LOMA Application Name: * Location/General Office: * Department: * Email: * Phone #: * Date of Birth(mm/dd/yr): * 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.
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