Extern Application

Please complete the form below

Please complete the application below. We also require a resume and 1 letter of recommendation from a faculty member. These can be submitted to Dr. Sara Holloway at crosstimbv@yahoo.com.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Undergraduate School

Veterinary School, Class, and Graduation Year

Desired length of externship

First choice proposed externship dates

Second choice proposed externship dates

Will you have transportation?

Do you request other accommodations? If so, please provide a brief description

Background information

Previous rural veterinary experience

Career interests:

3 general goals for CTVH externship:

3 specific goals for CTVH externship:

Extern Application

Please complete the form below

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