VTNA California Alternate Route Application

VTNA California Alternate Route Application

Complete your eligibility screening and applicant details for the upcoming cohort—submission does not guarantee admission.
Welcome & Cohort
Please submit your application with all requested supporting documents.
Cohort applying for
Acknowledgements
Applicant Information
Legal First Name
Middle Name
Last Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Country
Eligibility Screening
Are you at least 18 years old?
Highest education completed
I have a high school diploma or GED/equivalent and can provide proof
Have you completed 4,416 documented directed clinical practice hours under direct supervision of a California-licensed veterinarian?
Current employment status
Eligibility note
Veterinary Employment & Clinical Experience
Current employer/hospital
Facility address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Facility phone
Please enter a valid phone number.Format: (000) 000-0000.
Job title
Start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Average hours per week
Supervising California-licensed veterinarian name

First NameMiddle NameLast Name
Supervisor email
example@example.com
Supervisor phone
Please enter a valid phone number.Format: (000) 000-0000.
Brief summary of veterinary duties and clinical experience
Previous veterinary employers
https://vmb.ca.gov/applicants/rvt_tasklist.pdf
Please review the RVT Work Experience Task List using the link provided above and confirm that you understand it must be completed prior to starting the Vet Tech Nursing Academy program. Based on your current clinical experience, the majority of tasks on the form must already be completed and checked off. You may leave up to four tasks unchecked; the program will help you develop the skills and experience needed to complete those remaining requirements. Please review the form carefully to ensure your current experience meets the program’s expectations before submitting your application.
Education History
High School Name
City, State
Graduation Year
Date of Graduation

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Did you attend college or university?
College / University Attended
Years Attended
Degree or Certificate Earned
Relevant Coursework or Academic Achievements
Emergency Contact
Full Name

First NameMiddle NameLast Name
Relationship
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Referral
Where did you hear about VTNA?

Other
Referral details
Prior Application
Have you applied to VTNA before?
When did you apply previously?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Additional notes about your prior application
Applicant Statement
Why are you interested in the California alternate route, and what are your goals?
Anything else admissions should know
Required Acknowledgements
I acknowledge that the information I have provided is accurate and complete to the best of my knowledge.
I acknowledge that false or misleading information may result in application denial or disciplinary action.
I acknowledge that admission and VTNE eligibility are subject to applicable requirements and review.
I agree to provide supporting documents and authorize verification of my education, employment, and clinical experience as needed.
Applicant Signature
Typed Full Legal Name

First NameMiddle NameLast Name
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Optional Media Release
Optional release for photos and videos
Do you grant VTNA and All God's Creatures permission to use your photos or videos for program-related communications and promotion?
Should be Empty:

VTNA California Alternate Route Application

Welcome & Cohort

Applicant Information

Eligibility Screening

Veterinary Employment & Clinical Experience

Education History

Emergency Contact

Referral

Prior Application

Applicant Statement

Required Acknowledgements

Applicant Signature

Optional Media Release