833.663.0003 P.O. Box 24822 Richmond, VA 23224
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2025 Application for Registration (pre exam)

Application for Registration (COPSKT)
Applicant Eligibility (please select one)
Name
Gender
Mailing Address
Professional Work Experience:
Employer Address
Phone number and/or Email address
List: UNIVERSITY NAME | STATE | DATE ATTENDED | DEGREE | DATE AWARDED
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Submit an official academic transcript for EACH college/university listed above. A student transcript copy is acceptable if it is the official student copy from the school. All transcript information must be in English or be accompanied by a notarized translation to English. Ensure all required courses for eligibility are listed.
List: LOCATION | SUPERVISOR | DATES | # OF HOURS | DUTIES
A minimum of 1,000 hours of clinical experience mandatory. All experience must be under the supervision of a Registered Kinesiotherapist (RKT).
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Do you require special arrangements due to physical or cognitive impairments?
If Yes, please check the following special arrangements you are requesting and include documentation with this application according to the instructions for individuals with special arrangements. If the required information is not provided, special arrangements will not be made.
Service Fees: Non‐refundable Examination Application Fee: $100.00
Price: $100.00
Service Fees: Non-refundable Examination Application Fee: $100
Service Fees: Non-refundable Examination Application Fee: $100. (Exam Fee: $400 due after determination of eligibility)