| First Name * | Last Name * | ||
|---|---|---|---|
| Address Line 1 * | |||
| Address Line 2 | |||
| City * | State/Province * | ||
| Zip/Postal Code * | Country * | ||
| Phone * | Email Address * | ||
| College of Veterinary Medicine you are attending * | |||
| Year in program | 1st2nd3rd4th | Class Rank * | |
| Externship 1 | |||
| Location of Externship 1 * | Dates of Externship 1 * | ||
| Total Length of Externship 1 * | Other Sources of Funding & Amount Funded – Externship 1 * | ||
| Externship 2 | |||
| Location of Externship 2 | Dates of Externship 2 | ||
| Total Length of Externship 2 | Other Sources of Funding & Amount Funded – Externship 2 | ||
| Externship 3 | |||
| Location of Externship 3 | Dates of Externship 3 | ||
| Total Length of Externship 3 | Other Sources of Funding & Amount Funded – Externship 3 | ||
| Externship 4 | |||
| Location of Externship 4 | Dates of Externship 4 | ||
| Total Length of Externship 4 | Other Sources of Funding & Amount Funded – Externship 4 | ||
| Required Documentation | |||
| Letter to ACVP Externship Subcommittee | |||
| Letter to the ACVP Externship Subcommittee describing the externship to which you have been accepted. Include information on: a) your background (including a list of previous externship experiences), b) your goals for the experience, and c) a brief description of the externship environment (including location, dates, and the name of the ACVP Diplomate who is coordinating the experience). Be sure to include a description of the how the externship will broaden your pathology experience. | |||
| Upload Letter for Externship 1 * | |||
| Curriculum Vitae & CVM Transcript | |||
| Please upload your current Curriculum Vitate (maximum of 2 pages) and your unofficial CVM transcript. | |||
| Brief curriculum vitae * | |||
| Current CVM transcript (unofficial) * | |||
| Letter of Agreement | |||
| Letter of agreement from the host institution which specifies the location and duration of externship, if matching contributions are provided and, if so, amount of matching contributions. | |||
| Upload Letter of Agreement – Externship 1 * | |||
| Upload Letter of Agreement – Externship 2 | |||
| Upload Letter of Agreement – Externship 3 | |||
| Upload Letter of Agreement – Externship 4 | |||
| Letter of recommendation | |||
| Letter of recommendation from an ACVP, ECVP, or JCVP Diplomate. This person should not be the same person that is coordinating the externship experience. | |||
| Upload Letter of Recommendation * | |||
| Note: | |||
| If you would like to apply for more than four externships, please fill out this application again. | |||
| Annual Deadlines | |||
Notification of scholarship determinations will be sent approximately 4 weeks after each submission deadline. Applications must be submitted by the deadline.Scholarship checks will be distributed upon submission of an externship summary and completed W-9 form to the ACVP Executive Office. Review Intern/Externship Scholarship Opportunities here. Direct Questions to: [email protected] |
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