Externship Application

Student Name*

Phone*

Email*

Hospital Preference*

Please let us know which hospital(s) you'd like to attend for your externship.

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College of Veterinary Medicine*

Expected Graduation Date*

Previous Experience*

Please describe any previous veterinary work or volunteer experience.

Externship Objectives*

What would you like to accomplish during your externship? Are there any particular areas of focus or curriculum requirements?

1st Choice Start Date*

2nd Choice Start Date*

Length of Externship (1-8 weeks)*

How much time would you like to spend in our hospital? Externships range from 1-8 weeks.

Will you receive credit for your externship?*

Is this externship necessary for graduation?

How did you hear about us?

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Personal Information

Emergency Contact Name*

Emergency Contact Phone Number*

Emergency Contact Relationship to Student*

Do you have medical insurance?*

Insurance Carrier*

Insurance Policy Number*

Existing Medical Conditions

Do you have any medical conditions that we need to be aware of to accommodate your needs?

Allergies

Do you have any known allergies that we need to know about?

Resume*

Please attach your resume.

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Send me a copy of my responses