Online Elective Submission Form

Online Form

Use this online form to complete your elective submission. Please complete each field. Once you submit your form it will be emailed to the office responsible for posting these opportunities for our students.

Fields marked with an asterisk (*) are required.

College Directed Elective Experience

Type of Experience: *

Practice Name: *

Address: *

Telephone Number: * (xxx) xxx-xxxx

Fax Number: * (xxx) xxx-xxxx

Email Address: *

Website Address:

Clinical Supervisor of Elective: *

Description Experience: *

Institutional Resources:

(Associated Veterinarians and special expertise available (postgraduate training, Specialty Board, etc.)

Educational Resources Available:

(Journals, books, computer databases, rounds, continuing education activities, etc.)

Responsibilities Expected of Participating Students: *

Student Supervision: *

(Please estimate approximate number of hours per day and days per week that the student will have direct and free access to veterinarians.)

Is Student Housing Available?: *

Institution's Agreement: *

I agree to evaluate student performance and to report that performance back to the college within two weeks of the end of their experience.

I understand that the students will evaluate their experiences in the rotation and the result of their evaluation will be available to the clinical supervisor and to additional students for consideration for future experiences.

Check here if you are willing to accept students in future academic semesters on a mutual consent basis between your organization and the student applying for elective credit.

If this is a change, date of last update:

By submitting this online form, you agree that the above information is complete to the best of your knowledge. Any changes to the above information must be conveyed in writing or via this form.

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