Hagyard Externship Application Form
Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Country of Citizenship
*
Emergency Contact
*
First Name
Last Name
Phone Number
*
Relationship
*
Medical Insurance Company
Phone Number
-
Country Code
-
Area Code
Phone Number
Policy Number
Professional Information
Vet School
*
Graduation Date
*
-
Month
-
Day
Year
Date
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Externship Information
Have you completed an externship at Hagyard previously?
*
YES
NO
If YES, indicate departments and dates of previous externship here:
Primary Preference Dates
*
If your dates are flexible, please indicate a range:
*
Externship Options
*
Surgery
Internal Medicine
Field Care
Sport Horse
Theriogenology
Ophthalmology
Do you require dorm housing during your externship?
*
YES
NO
Transportation Requirement
Does your school or program have any specific requirements/forms required from our externship?
*
YES
NO
If YES, indicate requirements here:
Are you interested in potentially applying for a graduate traineeship program (internship or fellowship)?
*
YES
NO
If YES, please indicate which programs:
Internal Medicine Fellowship (6-month, January - June)
Adv. Internal Medicine Fellowship (12-month, January - December)
Adv. Internal Medicine Fellowship (12-month, July - July)
Surgery Internship (12-month, June - June)
Adv. Surgery Internship (17-month, February - June)
Field Care Internship (12-month, July - July)
Sport Horse Internship (12-month, July - July)
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Upload Supporting Documents
Upload CV
*
Browse Files
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pdf, doc, docx
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Upload Letter of Intent
*
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Profile Picture (image should be professional, no hats or sunglasses-- bonus for a smile!)
*
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jpg, jpeg, png
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Confidential Information Policy
By signing here, I acknowledge that I understand the Confidential Information Policy above and will fully comply with the letter and spirit of it.
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