new certificate transmittal form - university of...

New Certificate Transmittal Form

Department Name and Number

CIP Code

Certificate Name ______________________________________________________________________________ Certification Name for Transcript (Maximum 35 characters) ___________________________________________

Effective Year and Term

Amount of Credit __________

Certificate Description (50 words or less)

Requirements (Courses, internships, etc.)

Prerequisites

Certificate Level Baccalaureate Graduate Professional

Rationale and place in curriculum

Large Animal Clinical Sciences 2804-0000 51.2599

International Veterinary Medicine

Certificate International Vet Med

Current program 15

This is a 15-credit program parallel to the DVM curriculum that allows students to examine global health issues relevant to the public and the veterinary profession, and to apply veterinary knowledge in animal health, public health, or wildlife and conservation programs in a foreign country.

VEM 5931 Topics in Veterinary Medicine: seminars in international veterinary medicine (1+1 = 2 credits). VEM 5506 International Veterinary Medicine (1 credit). VEM 5904 Independent Study (2 credits). VEM 5892 Externship (abroad) (2 credits). VEM elective courses approved by the UF CVM veterinary curriculum (8 credits)

The student must be enrolled in the UF College of Veterinary Medicine DVM degree program. The student must be in good academic and professional standing. The student must identify a UF CVM faculty adviser willing to provide guidance and assistance throughout the course of the certificate program.

In 2003, the UF College of Veterinary Medicine established an Office of International Programs (OIP) in response to one of the ten areas considered in the UF Strategic Plan: Internationalization of the curriculum. The main objective is to provide DVM students with international education opportunities on campus and abroad during the 4-year curriculum. Students with interest in international veterinary medicine can participate in education initiatives offered at three levels. Level 1 is on campus, and students can sign for credit in the elective course VEM 5931 Topics in veterinary Medicine (Seminars in International Veterinary Medicine offered annually in the Fall semester). Level 2 is abroad, and students can sign for credit in the elective course VEM 5506 International Veterinary Medicine (offered in Spring, Summer, or Fall semester). Level 3 is on campus and abroad, and students can enroll in the certificate program in international veterinary medicine (15 credits).

✔

Student Learning Outcomes: List each outcome with its associated courses, assessment type (e.g. course-related exam/assignment/grade, final paper/project/presentation, standardized exam, capstone) and method (e.g. rubric, faculty committee, single faculty member).

Department Contact Name Phone Email

College Contact Name Phone Email

Outcome 1: The student will examine global health issues relevant to the public and the veterinary profession. Course: VEM 5931 Topics in Veterinary Medicine: seminars in international veterinary medicine (on campus) (1+ 1 = 2 credits). Assessment type: Attendance and seminar assignments. Grade is Satisfactory/Unsatisfactory/Incomplete. Method: Student must attend 8 of 10 seminar sessions. After each seminar, the student must complete a quiz-assignment with key topics covered in each seminar presentation. The student must have a passing score of 80% or greater in each quiz-assignment. Outcome 2: The student will apply veterinary knowledge in animal health, public health, or wildlife and conservation programs in a foreign country - under the supervision of a UF faculty member. Course: VEM 5506 International Veterinary Medicine (abroad) (1 credit). Assessment type: Attendance and pre- and post-evaluations. Grading system is S/U/I. Method: To obtain a satisfactory grade, the student must attend all lectures included in the course syllabus and must obtain a passing score of 80% or higher in the post-evaluation. Outcome 3: The student will conduct a literature review and describe the geography, history, cultural, socio-economical and political aspects of a selected foreign country in preparation for her/his international externship. Course: VEM 5904 Independent Study (on campus) (2 credits). Assessment type: The student prepares a final paper, which is a literature review and reaction paper of the country of interest. Grading system is letter grade. Method: Final paper is reviewed and graded by two UF CVM faculty members based on student’s writing skills and content. Outcome 4: The student will apply veterinary knowledge in animal health, public health, or wildlife and conservation programs in a foreign country - under the supervision of an international scholar. Course: VEM 5892 International Externship (abroad) (2 credits) Assessment type: Externship evaluation. Grading system is S/U/I. Method: Externship evaluation sheet is completed by an international scholar (host). Elective course-work (8 credits in elective courses approved by the UF CVM curriculum). An example of elective courses is the following: VEM 5352 Dairy Production Medicine: 1 credit. VEM 5176 Poisonous Plans: 1 credit. VEM 5510 Emerging diseases: 1 credit. VEM 5501 Clinical Epidemiology: 1 credit. VEM 5737 Large Animal Surgery Clerkship: 2 credits. VEM 5991 Individualized Investigation: 2 credits.

Jorge Hernandez 294 4305 [email protected]

Pam Ginn 294 4193 [email protected]

Jorge Hernandez

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VEM 5931 Topics in Veterinary Medicine: seminars in international veterinary medicine

Fall 2012

Revision: October 23rd, 2012

I. Course information

Number: VEM 5931

Course Title: Topics in Veterinary Medicine (seminars in international veterinary medicine)

Phase: 1,2,3

Semester: Fall

Year: 1VM, 2VM, 3VM

Course credits: 1

II. General information

Course director: Jorge Hernandez

Office location: Deriso Hall, Room 120

Office hours: email is the best way to schedule an appointment

Office phone number: 352 294 4305

Email: [email protected]

www.ufvetmedepidemiology.com

Course Faculty: Jorge Hernandez and invited speakers

III. Course description

The seminar series in international veterinary medicine is an education initiative designed to

enhance student awareness in global health issues relevant to the public and the veterinary

profession, and to facilitate student international education/research opportunities. The seminar

series include an introductory session and ten seminar presentations by UF veterinary students,

residents, graduate students, faculty, and invited speakers engaged in international work. The

class meets at the UF CVM Lecture Hall B on Tuesdays and Thursdays from 530 to 700pm (see

schedule below). The seminar series in international veterinary medicine is offered in the Fall

semester only.

Student learning outcomes

Students will examine global health issues relevant to the public and the veterinary

profession.

Students will identify international education/research opportunities.

Seminar’s format

5.00 – 5.30pm Social gathering (refreshments)

5.30 – 6.30pm Seminar presentation

6.30 - 7.00pm Seminar discussion (Q&A)

Schedule: Fall 2012

Date Day Topic Presenter

9/18 T Seminars in International Veterinary Medicine:

Introduction

Jorge Hernandez

mailto:[email protected]

http://www.ufvetmedepidemiology.com/

2

Schedule: Fall 2012 (continued)..

Date Day Topic Presenter

9/25 T Malnutrition and zoonotic GI parasite burden in

children in rural YUCATAN

Joelle Glenn (2013)

9/27 Th Proyecto Tití: An Integrate Approach to Conserving

COLOMBIA’s Most Endangered Primate

Ann Savage*

10/2 T Wildlife conservation efforts in GALAPAGOS Nicole Compo (2013)

10/4 Th No seminar today

10/9 T Food animal (dairy) practice in ARGENTINA Lucas Ibarbia

Natalie Yoguel (2015)

10/11 Th Elephant conservation efforts in THAILAND Sean McFly (2015)

10/16 T Food animal (dairy) practice in BRAZIL Joao Bittar

10/18 Th Jaguar conservation efforts in BELIZE Alexandra Gould

(2015)

10/23 T International experiences in a career Paul Nicoletti

10/25 Th Small & Food animal education opportunities in

BOSNIA & HERSEGOVINA

Scott Cornwell**

Herbert Maisenbacher

10/30 T UF and USDA FAS capacity building and training

efforts in animal health in PERU: what, why, how…

Jorge Hernandez

*Anne Savage, PhD, Conservation Director, Walt Disney Parks and Resorts.

** Colonel, US Army (retired).

IV. Course materials

Course materials (abstract of seminar presentation, biographies of speakers, assigned

reading materials) will be distributed to students 2 or more days before each seminar

presentation.

A seminar quiz-assignment will be distributed at the beginning of each seminar

presentation.

V. Evaluation

Exams: No.

Other assignments: Yes.

Students must read course materials before class.

Students must complete a quiz-assignment after each seminar presentation.

Grading system: Satisfactory/Unsatisfactory/Incomplete.

To obtain a satisfactory grade:

The student must attend at least 8 of 10 seminar presentations.

The student must complete each quiz-assignment and obtain a passing grade of 80% or

higher in each assignment.

VI. Administrative Policies: see Student Handbook @

http://www.vetmed.ufl.edu/education/documents/studentHandbook.pdf

Remediation

Attendance


3

Academic Honesty

Professional Behavior

Deadline

Student Evaluation of Instruction

Accommodations for Students with Disabilities

Student Safety

VII. Other information

Seminar’s etiquette

Please arrive at least 5 minutes before the seminar presentation starts.

Please read course materials before class.

Engage and participate in the Q&A sessions.

Reading/studying for other courses or texting or taking phone calls during a seminar

presentation is not allowed.

For more information, please contact Dr. Jorge Hernandez, Professor and Director of

International Programs at [email protected]; www.ufvetmedepidemiology.com; Tel (352)

294 4305.



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VEM 5506 International Veterinary Medicine: Colombia

Spring 2013



Number: VEM 5506

Course Title: International Veterinary Medicine

Phase: 1,2,3

Semester: Fall, Spring, or Summer

Year: 1VM, 2VM, 3VM

Course credits: 1








Course Faculty: Natalie Isaza, Ramiro Isaza, Jorge Hernandez

Invited Instructor: Anne Savage


This is an introductory course in wildlife conservation, animal health and public health in

Colombia in collaboration with Proyecto Tití http://proyectotiti.com/ and Walt Disney. UF DVM

students can gain academic credit under the elective course VEM 5506 International Veterinary

Medicine (1 credit).

The Cotton-top tamarin Saguinus oedipus is a critically endangered primate found only in

Colombia. These tamarins are a popular exhibit animal in zoos and an important research subject

in the study of colon cancer and reproductive biology and

behaviour; efforts to create a self-sustaining captive-breeding

population for this species have been very successful. With the

wealth of information on biology, captive management and status

in the wild, efforts are now focused on ensuring that Cotton-top

tamarins continue to remain in the wild. With large-scale

development threatening some of the last remaining forested areas

for the species and its popularity in the illegal pet trade,

compounded by the constant extraction of forest resources by

impoverished communities, strategies are needed to protect this

species effectively for the future. This presentation will be an

overview of a successful, multi-disciplinary conservation program

developed by Proyecto Tití, which involves local communities,

national and international agencies, and the conservation

community in the long-term protection of one of Colombia’s most threatened species.

Photo by: Lisa Hoffner

Hoffner



http://proyectotiti.com/

2

General student learning outcome

Students will apply veterinary knowledge in animal health, public health, or wildlife and

conservation programs in a foreign country - under the supervision of a UF faculty

member(s).

Specific student learning outcomes

Students will examine the hazards that threaten the survival of the Cotton-top tamarin in

Colombia.

Students will examine zoonotic diseases that can affect domestic animals and people in

rural communities near the Cotton-top tamarin’s habitat in Colombia.

Students will conduct an epidemiologic study to estimate the population of domestic

animals in the rural communities.

Students will assess and identify exposure factors associated with a positive diagnosis to

selected pathogens (eg, gastro-intestinal parasites) in domestic animals in the rural

communities.

Students will apply veterinary knowledge and clinical skills required for animal control

education efforts and prevention of diseases in dogs and cats in the rural communities.

The course is structured in two parts. Part I will be held at University of Florida and Part II in

Colombia. The course will be comprised of 22 instructional units (1 semester credit - elective)

and will be delivered as detailed in the course syllabus (below). This course will be offered in

English. Proficiency in Spanish is preferred but not required.

Tentative schedule: March 11-23, 2013

Date Day Time Location Topic/Activity Instructor(s) IU

Part I

3/11 Mon 600-800pm UF CVM Course overview

Course pre-evaluation

Hazards that threaten the

survival of the Cotton-top

tamarin in Colombia.

J Hernandez 1-2

3/12 Tues 600-800pm Introduction to Colombian

culture

TBA 3-4

3/13 Wed 600-800pm Zoonotic diseases affecting

domestic animals and people in

rural communities near the

Cotton-top tamarin’s habitat

R Isaza 5-6

3/14 Th 600-800pm Spay-neuter and vaccination

procedures in dogs and cats

N Isaza 7-8

3/15 Fri 600-800pm Field epidemiologic studies:

data collection

J Hernandez 9-10

3/16 Sat Departure to Rafael Nuñez International Airport in Cartagena, Colombia (CTG).

Students make own travel arrangements.

3

Tentative schedule: March 11-23, 2013 (continued)..


Part II

3/18 Mon 700-900am Colombia Travel from Cartagena to the Forest of El Ceibal

900-200pm

On-going efforts to support the

survival of the Cotton-top

tamarin

Field observations of Cotton-

top tamarin in the Forest

A Savage 11-12

200-300pm Travel to Los Límites

300-400pm Town hall meeting in Los

Límites

NA

400-600pm Travel to Cartagena

3/19 Tue 700-900am Travel from Cartagena to Los Límites

900-400pm Team A: Spay-neuter and

vaccination clinic in dogs and

cats

N Isaza

R Isaza

13-16

900-400pm Team B: Field epidemiologic

studies: data collection and

house-to-house vaccination of

dogs and cats

J Hernandez


3/20 Wed 700-900am Travel from Cartagena to Los Límites

900-400pm Team A: Spay-neuter and

vaccination clinic in dogs and

cats

N Isaza 17-20




dogs and cats

R Isaza

J Hernandez


3/21 Th 700-900am Travel from Cartagena to Los Límites

900-200pm Team A: Post-operatory

observations in dogs and cats

N Isaza 21-22




dogs and cats

R Isaza

J Hernandez

200-400pm Meeting with Principal and Teachers at the local

School in Los Límites: the curriculum, brainstorm of

initiatives or collaborations that can potentially

empower the curriculum, and tour of facilities


4

Tentative schedule: March 11-23, 2013 (continued)…


Part II

3/22 Fri 700-900am Colombia Travel from Cartagena to Los Límites

900-100pm UF Science Lab for Kids N Isaza

R Isaza

A Savage

J Hernandez

NA


3/23 Sat Return to the States + course post-evaluation and feedback


Reading materials will be distributed to students during the first session (course overview).

V. Evaluation

The course grade (satisfactory/unsatisfactory/incomplete) will be determined by the student’s

lecture attendance and a pre- and a post-evaluation. The student must attend all lectures included

in the course schedule. The pre- and post-evaluations will cover topics presented in Parts I and II

of this course. A passing score ≥ 80% in the post-evaluation is required to obtain a satisfactory

grade.



Remediation

Attendance

Academic Honesty


Deadline



Student Safety


Requirements

Students in this class must be in good academic and professional standing.

Students in this class must be vaccinated against rabies and/or have current, positive

titers.

MEDEX (emergency evacuation insurance) on-line travel registration at the UF

International center http://www.ufic.ufl.edu/travelregistration.html

Students in this class must have current medical insurance.

Approval of the course coordinator.

Travel documents

Entry requirements for US citizens into Colombia are: valid US passport.


http://www.ufic.ufl.edu/travelregistration.html

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Housing accommodations in Cartagena, Colombia: TBD.

CDC travel information

Please see health information for travelers to Colombia at:

http://wwwnc.cdc.gov/travel/destinations/colombia.htm

Course (class) size limit: In 2013, this course is limited to a maximum of 6 UF DVM students.

Student scholarships: There is funding available to cover the cost of airfare (to/from Cartagena,

Colombia) to students selected for this course.

Estimated cost: ~ $500 (students manage own funds) for hotel accommodation (7 nights) and

meals (B,L,D) while in Colombia.

http://wwwnc.cdc.gov/travel/destinations/colombia.htm

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VEM 5904 Independent Study



Number: VEM 5904

Course Title: Independent study

Phase: 1,2,3

Semester: Fall

Year: 1VM, 2VM, 3VM

Course credits: 2


Course director: UFCVM faculty






Course Faculty: UF CVM faculty


Students pursuing the Certificate in International Veterinary Medicine must complete this course

before they begin the required International Externship. This is a two-credit course designed to

prepare the student with information she/he needs to know about the country where the

international externship will be conducted.

Student learning outcomes

The student will conduct a literature review and describe the geography, history, cultural,

socio-economical and political aspects of a selected country in preparation for her/his

international externship.

After the literature review is completed, the student will identify cultural, socio-

economical and political aspects (or other aspects) that may have an impact on her/his

ability to successfully complete the international externship, and explain what measures

she/he will implement to mitigate such impact(s).

Course format

The student will identify a faculty adviser, who will provide guidance and assistance to

accomplish the student learning outcomes.

The student will be responsible to conduct a literature review covering at least 16 topics

relevant to the country of interest and course objective. For example: (1) geography (2)

history (3) demography (4) political system (5) justice system (6) religion (7) economy

(8) natural resources (9) transportation (10) telecommunications (11) public health (12)

animal health, (13) environmental health (14) education (15) veterinary medicine



2

education (16) social issues: women (17) men (18) teenagers (19) children (20)

immigration (21) AIDS (22) poverty (23) animal control (24) animal welfare (25) historic

or current events linked to the US (26) US embassy (27) other topics identified by the

student and faculty supervisor as relevant.

The student will meet with her/his faculty adviser bi-weekly (or more often) for guidance

and assistance and to assess progress.

Outputs

The student will prepare a 20-page document (singled-spaced) structured in two parts. Part I

should be a literature review describing the sixteen topics of interest (16 pages). The literature

review section must include references clearly identified on the text and a references’ section.

Part II should be a synthesis with the student's reaction to the information presented in Part I (4

pages). Specifically, the student will identify issues that may have an impact on her/his ability to

successfully complete the international externship and explain what measures she/he will

implement to mitigate such impact(s). The student should consult with the UF CVM Office of

International Programs (OIP) or her/his faculty advisor for further instructions on how to prepare

and submit the 20-page document electronically for review and grading. The software "Turnitin"

is an on-line tool used by the OIP to check the originality of the paper submitted for review and

grading.


The student is expected to use library resources (on campus, online) to accomplish the

student learning outcomes identified above.

V. Evaluation

Exams: No

Other assignments: No

Students must complete a quiz-assignment after each seminar presentation.

Grading system: letter grade.

The 20-page document will constitute 100% of the final grade. The document should be

submitted to the course director via email ([email protected]). The document will be

reviewed and graded by two UF CVM faculty members (faculty within the college or university;

or scholars from participant institutions abroad). Course grade will be based on student’s writing

skills and content. The final course grade will be assigned by the course director based on

feedback provided by the two reviewers.



Remediation

Attendance

Academic Honesty


Deadline




3


Student Safety


For more information, please contact Dr. Jorge Hernandez, Professor and Director of

International Programs at [email protected]; www.ufvetmedepidemiology.com; Tel (352)

294 4305.



1

VEM 5892 Externships in International Veterinary Medicine (2 credits)


Number: VEM 5892

Course Title: VEM 5892 Externships in International Veterinary Medicine

Phase: 3

Semester: Summer

Year: 3VM

Course credits: 2








Course Faculty: UF CVM faculty


The International Externship is an education opportunity for veterinary students who are

pursuing the Certificate in International Veterinary Medicine. The externship must be held in a

foreign country over a two-week period during the summer semester, after the junior year is

completed. During this time, the student will work with a mentoring veterinarian involved in

animal health, public health, or wildlife and conservation programs.

All externship sites are approved through an application process conducted through the College

of Veterinary Medicine Office of Students & Instruction and evaluated by the college

Curriculum Committee.

Student learning outcome

The student will apply veterinary knowledge in animal heath, public health, or wildlife

and conservation programs in a foreign country – under the supervision of an

international scholar.

IV. Prerequisites VEM 5904 Independent Study (2 credits).

Successful completion of the freshman and sophomore veterinary curriculum.

The student must be in good academic and professional standing.

V. Course Materials

Required texts: No texts are required for this course.

Required Attire: Students will comply with the CVM dress code and the requirements of the

host facility.



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VI. Evaluation/ Grading/ Testing

Grading system is Satisfactory/Unsatisfactory/Incomplete

Students who miss more than an average of 1 day per week will receive an incomplete

until the externship is completed to the satisfaction of the supervising veterinarian.

Students will write a summary report describing the activities and cases during the

externship.

Students will provide their externship supervising veterinarian with the ‘Evaluation of

Student by Supervising Veterinarian’ sheet to complete and submit to the Office of

Students and Instruction. Clinical knowledge and performance in several areas will be

evaluated on a 5-point scale from “poor” (1 point) to “excellent” (5 points).

A passing externship grade requires a minimum of 80% attendance, an acceptable

externship report, and an average score of 3.0 or higher on the evaluation by the

supervising veterinarian.

VII. Administrative Policies

For more information about professional veterinary student expectations, policies, and

requirements, see the Veterinary Student Handbook at: http://education.vetmed.ufl.edu/student-

services/student-handbook-pdf/

Academic Honesty Policy

Plagiarism includes any attempt to take credit for another person’s work, even in a discussion.

Cheating, lying, misrepresentation, or plagiarism in any form is unacceptable and inexcusable

behavior.

All students registered at the University of Florida have agreed to comply with the following

statement: “I understand that the University of Florida expects its students to be honest in all

their academic work. I agree to adhere to this commitment to academic honesty and understand

that my failure to comply with this commitment may result in disciplinary action up to and

including expulsion from the University.” In addition, on all work submitted for credit the

following pledge is either required or implied: “On my honor I have neither given nor received

unauthorized aid in doing this assignment.” To review the student honor code please visit:

http://www.dso.ufl.edu/judicial/honorcodes/honorcode.php


Students requesting accommodations must first register with the Dean of Students Office,

Disability Resource Center. For more information, visit the Disability Resource Center website

at: http://www.dso.ufl.edu/drc/

Software Use

All faculty, staff and students of the University are required to obey the laws and legal

agreements governing software use. Failure to do so can lead to monetary damages and/or

criminal penalties for the individual violator. Because such violations are also against University

policies and rules, disciplinary action will be taken as appropriate.

http://education.vetmed.ufl.edu/student-services/student-handbook-pdf/

http://education.vetmed.ufl.edu/student-services/student-handbook-pdf/

http://www.dso.ufl.edu/judicial/honorcodes/honorcode.php

3

UF Counseling and Wellness Center

Many resources are available for students who need help with stress-related problems or

emergencies. Assistance is available both by appointment and after hours by calling 352-392-

1575 or visiting the website at: http://www.counseling.ufl.edu/cwc/

Crisis intervention is always available 24/7 from Alachua County Crisis Center: (352) 264-6789.

BUT – Do not wait until you reach a crisis to come in and talk with us. We have helped many

students through stressful situations impacting their academic performance. You are not alone

so do not be afraid to ask for assistance.

Grade Changes

Grades will be changed only when a grading error has been made.

Attendance

Attendance is mandatory and any unexcused absence may result in a failing grade for this course.

Class Participation and Professionalism

Students are expected to participate constructively and professionally in all discussions and

activities. Every interaction between classmates and/or faculty must be polite and professional.

While traveling, your appearance and actions reflect on the UF College of Veterinary Medicine.

You are expected to dress professionally in appropriate attire as directed by your instructors and

to represent the University of Florida in a favorable manner through your dress, good

communication skills and actions.

Performance Expectations

Students are expected to produce quality work of a standard comparable to any graduate-level

didactic course. All assignment submissions and discussions must be legible, constructive and

appropriate. Students are required to think for themselves and will be expected to complete

assignments that require the application of logic and reasoning skills when the answer may not

be found in a book or the course notes. Factual information should be documented and

referenced during discussions and within assignments.

Request for Externship Program Approval

University of Florida (UF) College of Veterinary Medicine (CVM)

The UF CVM Curriculum Committee will use this form to make initial decisions regarding whether to approve or deny your proposed externship. Please complete this form giving appropriate attention to all areas and then return the form directly to Ms. Dot McColskey,

Veterinary Curriculum Office at, Box 100125 Health Science Center, College of Veterinary

Medicine, Gainesville, Florida 32610 either by mail, e-mail [email protected] or fax (352) 846-2744 respectively.

*** Please Print Legibly or Type Requested Information ***

Name of Supervising Veterinarian:_________________________________________________________ Note: Only one veterinarian may serve as externship supervisor. Practice Name:___________________________________________________________________ Street Address: ___________________________________________________________________ City, State, Zip Code: _____________________________________________________________ Telephone Number: ( ) - Fax Number: ( ) - E-mail Address: ________________________________________________________________

Classification of Proposed Externship Program (please check only one classification).

Small Animal Externship Mixed Animal Externship Humane Society Externship Feline Externship Food Animal Externship Wildlife Externship Equine Externship Public Health Externship Zoological Externship Other Externship (Please Specify): _____________________________________________________

Externship Type (please check only one)

Academic/Research Patient Care/Private Practice Public Health/Animal Shelter Other: ___________________________

Number of veterinarians with whom student would directly interact: ______________________________ Do any of these veterinarians hold If yes, please list specialty board(s) specialty board certification? ________________________________________________________

Yes ________________________________________________________ No ________________________________________________________

Proposed externship duration: Note - College will only approve externships 2-8 weeks in total duration 2 weeks 4 weeks 8 weeks Variable 2-8 weeks: to meet individual student needs During the externship, will the student receive: Stipend? Housing?

Yes If yes, amount: $_______ Yes No hourly weekly biweekly No

-continued on back-


Key Accompanying Documents Required for Program Approval

Please attach a typed statement detailing the following: *Please do not answer the questions below on this same application. Please adhere to the request above and attach

a separate paper to the application with the details. All applications not in compliance with this request will be

returned for revision(s).

Reason(s) you have decided to offer your proposed externship program.

Responsibilities/work load extern will have.

Hours extern will be required to work, including any optional hours they may work.

How a student may apply to your externship program. (Please include point-of-contact person).

Details on housing (if provided/offered).

Details on stipend (if provided).

Brief description of practice including, how things run and operate, average number of cases seen weekly, monthly or annually, types of cases seen, description of facility, etc.

Any additional information our college and applying student(s) should know. I have read and understand my responsibilities to both teach and evaluate each extern granted permission to complete this proposed externship program. Signature of Supervising Veterinarian Date

For College Use Only Date Received: __________________ Approved Denied

——————————————————————————— ————————————— Signature of Curriculum Committee Chair Date