Portland VA Medical Center

Eye Care Training - Without Compensation Optometry Resident Application Materials

Eye Care Team - Without Compensation Optometry Resident Application Materials

The following forms are required for Pacific University College of Optometry (PUCO) sponsored optometry residents with clinical rotations at the Portland VA Medical Center without compensation from the VA (WOC). Although your residency program is funded by PUCO instead of the VA, you will need to complete the VA's application process before you will be able to provide patient care or access the electronic patient record system at our facility. I regret the paperwork is somewhat voluminous, but we will need you to complete the 5 attached forms, make copies for your self, and return them to us at least 30 days prior to the first day of your residency program. This lead time is required for timely processing of the application through our Education Service, Medical Staff Office, and Human Resources. Human Resources will contact you within 2 weeks of your start date to schedule fingerprinting and to complete your background check.

• Application Cover Page 
• VA Form 10-2850b (Application for Residents)
• Optional Form 306 (Declaration for Federal Employment)
• SF 181, Ethnicity and Race Identification 
• Statement of Commitment and Understanding for VA Trainees 
• VA Form 10-0410 (Clinical Trainee Registration Form)
• VA Form 4637 (Employee Education Data)
• Without Compensation & Instructor/Student Registration form 

Adobe Acrobat Reader is required to read these forms

Please hand deliver or mail your completed application materials to myself or Iva Walker (Eye Care Team Program Manager) at:

Portland VA Medical Center
P.O. Box 1034 / P-5-Eye
Portland, Oregon 97202