UVH Veterinary Student Externship Form

1
Full Name* This field is required.
First Name
Last Name
2
Go By Name
3
Cell
Area Code
Phone Number
4
Email
example@example.com
5
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Home Town
7
Which program at UVH are you requesting?
Externship/4th year vet school rotation (currently in vet school)
Internship/Shadow (undergrad student/need to know if this is for a grade)
Internship/Shadow (vet tech student/need to know if this is for a grade)
8
School
9
Degree obtaining when graduating
10
Date Of Expected Graduation
Date
Year
Month
Day
11
Picture permission for team education and UVH social media* This field is required.
Yes
No
12
LIABILITY: We do require that you have the AVMA PLIT student coverage for your externship. We will need a copy of the certificate for our files prior to your start date.Just upload it here or you can email m.wilcox@uvhvets.com.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
13
How did you hear about UVHvets?
14
What are your plans after you graduate?
Huge
Large
Normal
Small
Ok
Ok
15
How long will you be with us?
2 weeks
4 weeks
16
First Choice - Start Date
Date
Year
Month
Day
17
Second Choice - Start Date
Date
Year
Month
Day
18
Third Choice - Start Date
Date
Year
Month
Day
19
Do you need the UVH apartment?
YESNO
20
FOCUS

What are the top 3‐5 things you want to learn more in depth? Surgery skills, dental skills, customer service, anesthesia monitoring, internal medicine, oncology, ultrasound, radiology etc. UVH has found that students get more individual learning if assigned with one lead UVH doctor for ½ week or full week intervals. There is one lead DVM assigned to the extern as a coordinator and will be the person responsible for all paperwork and grading. Currently this is Dr. Catherine P. Foret.

UVH does have 3 Specialists - Oncology, Ophthalmology, and Rehab Therapy. If you have requested in depth shadowing with one of them that is great. If you want to shadow them for a day or two that can be arranged as well.
21
What are your top 5 Focus Topics in OrderWe are a full service small animal clinic mixed with several specialists. If wanting to just be with (1) VVC Veterinary Vision Center Ophthalmologist Dr. Kenneth Pierce (2) Dr. Amanda Beck Oncologist or (3) Dr. Jennifer Martinson sports medicine, rehab and chiropractor - please note that below. If you are interested in generalized areas but want to have a day or two with one of the specialists that can be arranged! Its a neat atmosphere to have GP and Specialists under one roof.
Topic
1
Row 0, Column 0
2
Row 1, Column 0
3
Row 2, Column 0
4
Row 3, Column 0
5
Row 4, Column 0
1
2
3
4
5
Topic
Row 0, Column 0
Topic
Row 1, Column 0
Topic
Row 2, Column 0
Topic
Row 3, Column 0
Topic
Row 4, Column 0
1 of 5
22
Signature* This field is required.
Clear
Should be Empty: