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*Required field.


To be completed by all applicants

Required for students only.

Your mobile phone number will be used to contact you after graduation to update your contact information.

Would you like to receive text messages from the Allergan® OPTOMETRY JUMPSTART® program?

Examples of texts include messages regarding the status of product sample shipments, appointment scheduling, and other resources. Consent to receive texts is not required as part of the OPTOMETRY JUMPSTART® program.

The frequency of these messages depends on user preferences/activity, and message and data rates may apply. You can unsubscribe at any time by texting "STOP".


To be completed by fourth-year students and graduates only

Are you, or will you be, employed by any of the following in the next 12 months?


To be completed by all applicants

The categories of personal information collected in this form include contact information, optometry school, graduation year, and employment. The personal information collected will be used for enrollment and participation into the OPTOMETRY JUMPSTART® program and to perform research and analytics. For more information about the categories of personal information about you that may be collected by AbbVie and the purposes for which AbbVie may use personal information about you, visit