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Veterinary Externship Application

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Emergency Contact: Name and Phone Number *

Anticipated Graduation Date *

Please indicate you level of comfort and experience with the following procedures:

(this is only for our knowledge to have an idea of where you are starting from)

Dog Spays

Comfort Level *

Very Comfortable

Comfortable

Need More Experience

Never Done

Number Performed *

0

0-5

6-10

More then 10

Please explain your answers, where have you performed these surgeries, did you have supervision etc... *

Dog Neuters

Comfort Level *

Very Comfortable

Comfortable

Need More Experience

Never Done

Number Performed *

0

0-5

6-10

More then 10

Please explain your answers, where have you performed these surgeries, did you have supervision etc... *

Cat Spays

Comfort Level *

Very Comfortable

Comfortable

Need More Experience

Never Done

Number Performed *

0

0-5

6-10

More then 10

Please explain your answers, where have you performed these surgeries, did you have supervision etc... *

Cat Neuters

Cat Neuter *

Very Comfortable

Comfortable

Need More Experience

Never Done

Number Performed *

0

0-5

6-10

More then 10

Please explain your answers, where have you performed these surgeries, did you have supervision etc... *

Please tell us why you are interested in an externship with Spay Me! and what you hope to get out of your time with us. *

Please click on the link below to sign-up for available dates. We ask that you spend two weeks with us, including at least one Saturday during your rotation. No exceptions will be made.

https://www.signupgenius.com/go/60B0845ACAA5-veterinary1

Affiliate agreement links need to be emailed to:

operations@wicvc.org

Evaluation forms will be completed by the Doctor overseeing your rotation, which will be assigned about a week prior to your externship start date.

How did you hear about the externship opportunity at Spay Me! ? *

Veterinary Extern MOU

Participation in the Spay Me! Clinic's Veteriney Extership program will be contingent on agreement to the rules and regulations of the facilty. Violation of these will be grounds for program dismissal.

1. The student is expected to maintain an open mind and an inquisitive attitude.

2. The policies and protocols of the Spay Me! Clinic administration and medical department must be observed and adhered to.

3. The student has read through and understood the training program syllabus details, as described on the Spay Me! website, for the Veterinary Externship.

4. There is no stipend for this position

5. Pre-existing medical conditions must be reported to the Spay Me! administration

6. Timeliness is imperative for program function. The routine student experience is scheduled from 7:00 AM until 6:00 PM Monday through Friday, and an occational Saturday. The clinic's regular weekly schedule includes 3 to 4 days of high volume spay and neuter, 5 days of primary care, 2 days of dentals and 1 day of other surgical procedures. Students will be expected to particiapate in all aspects of the clinic opperations, and will not only be performing spays and neuters.

7. Reasonable wear and tear of Spay Me! property is expected. The student is responsible for excessive and unreasonable damage of Spay Me! Property.

8. Please use your discretion when smoking on both time and place, as well as be sure you dispose of the smoking debris properly.

9. Daily attire (scrubs) should be commensurate with that worn during university surgical rotation reserved to the surgical suite.

10. The student understands that Spay Me! may use any photographs or videos taken of them or statements made by them, during the externship, or regarding the externship, for their promotional/grant-writing purposes.

11. The Student is expected to be respectful to the Spay Me! staff at all times.

*