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Off-Site Elective Registration Form

(for sites to complete)

 A note to the Practice:  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

Practice Information
(xxx) xxx-xxxx
(xxx) xxx-xxxx
Experience
Please select the closest match ( if multiple, ctrl click)
Please choose the sub-category of the experience, if applicable. (If multiple, ctrl-click)
(Associated Veterinarians and special expertise available (postgraduate training, Specialty Board, etc.)
(Journals, books, computer databases, rounds, continuing education activities, etc.)
(Please estimate approximate number of hours per day and days per week that the student will have direct and free access to veterinarians.)