<p> USNA Candidate Spectacle Prescription Form (Required for all candidates who wear glasses or contact lenses)</p><p>Candidate Information (complete all sections): Name (Last, First MI): Social Security Number (required): - - Sex: Male Female Phone #: </p><p>Glasses Prescription (To be completed by a licensed eye care professional): Pupil mm Distance: (OU) SPH CYL AXIS PRISM OD: OS: Eye care professional’s signature & stamp</p><p>Glasses Frame Size Lens and bridge width (in millimeters) -</p><p>Instructions: 1. Only candidates that wear glasses or contact lenses should complete this form. 2. Fill out the form completely (including FULL social security number). Have your local eye care provider complete the “Glasses Prescription” section. 3. Return this form no later than 15 May 20 15 by either fax or e-mail: o Fax to: 410-293-1131 (no cover sheets or other forms) or o Scan and email to: [email protected] (In the email subject line, please type: “Plebe Summer Glasses Order”) 4. For questions about this form, contact the USNA Optometry Dept. at 410-293-3617.</p><p>Important information for contact lens wearers:  Do not wear contact lenses on I-day.  You cannot wear contact lenses or civilian glasses at all during Plebe Summer.  This form will be used to issue military training spectacles for use during Plebe Summer. After Plebe Summer is over you can resume wearing contact lenses and/or civilian glasses.  Bring your current contact lens prescription (or boxes) and a supply of contact lenses for use AFTER Plebe Summer. We do not provide contact lenses for you.</p>