Veterinary Technology Application

This field is for validation purposes and should be left unchanged.

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Crowder Student ID Number

Email*

Phone Number*

Alternate Phone Number

College Education #1

List high school or GED and colleges Attended

Name of School*

Address of School*

Street Address City State

Start Date*

End Date*

Add a Second School

Yes
No

College Education #2

List high school or GED and colleges Attended

Name of School*

Address of School*

Street Address City State

Start Date*

End Date*

Add a Third School

Yes
No

College Education #3

List high school or GED and colleges Attended

Name of School*

Address of School*

Street Address City State

Start Date*

End Date*

Do you have college ready scores for:

Have you completed Biology or Zoology with a minimum grade of a "C"?*

Yes
No

Have you completed Biology 101?*

Yes
No

Have you completed English 101?*

Yes
No

English (are you at ENGL 101 or above)?*

Yes
No

What level of math have you completed?

What is your GPA?

Occupational Experience

List all employment within the past 5 years, start with the last date of employment (Employers may be contacted as references)

Employer*

Employer Address*

Street Address City State

Type of Employment*

Start Date

End Date

Add a Second Employer

Yes
No

Occupational Experience

List all employment within the past 5 years, start with the last date of employment (Employers may be contacted as references)

Employer*

Employer Address*

Street Address City State

Type of Employment*

Start Date

End Date

Add a Third Employer

Yes
No

Occupational Experience

List all employment within the past 5 years, start with the last date of employment (Employers may be contacted as references)

Employer*

Employer Address*

Street Address City State

Type of Employment*

Start Date

End Date

Work Experience within Veterinary Medicine*

list all animal related experience, and the number of years in each capacity (include experience with animal husbandry)

References

Please list the names and complete mailing addresses of three persons (not relatives or friends) who can evaluate your aptitude for the veterinary technology profession. Recommendations should be from a practicing veterinarian, a college instructor, and another person of the applicant’s choice. (Employers who can speak to work ethic are often a good option.) Letters may be mailed directly to the Veterinary Technology Program Director prior to the application deadline, or may be submitted with the application.

Reference #1*

First Last

Address*

Street Address City State ZIP Code

Phone

Reference #2*

First Last

Address*

Street Address City State ZIP Code

Phone

Reference #3*

First Last

Address*

Street Address City State ZIP Code

Phone

Clinic Name and Location of Observation Hours

Number of Observation Hours Completed

Overall GPA

Please complete the Proof of Shadowing form.

Essay 1*

Please write an essay of 250-500 words on the following subject: The Veterinary Nurse Initiative (VNI), which seeks to unite the veterinary technician profession under a single veterinary nurse title, standardize credentialing requirements and define scope of practice, continues to make progress despite some challenges. Detail your thoughts on this trend and describe any characteristics or experience which will set you apart from other candidates.

Essay 2*

Please write a 1/2 page essay on the following subject: From time to time, euthanasia is practiced in the field of veterinary medicine. Convey your thoughts about euthanasia. In your response, include whether or not you think that euthanasia should be practiced and why you have arrived at that conclusion.

Acknowledgements

Acknowledgement 1*

I do hereby certify that the above information is complete and correct to the best of my knowledge under penalty of perjury.

Yes I Understand

Acknowledgement 2*

I understand that any question answered in a false manner will result in the application being void.

Yes I Understand

Acknowledgement 3*

I understand that I will not be considered for admission into the Veterinary Technology Program until I have completed the application process as outlined in the application information sheet.

Yes I Understand

“The Family Educational Rights and Privacy Act of 1974”, Public Law 93-380 as amended and signed into law by President Ford on December 31, 1974, states that enrollees have the right to examine confidential files. It also states that they may waive this right if they do so desire.

The law provides that references may be either confidential or non-confidential at the option of the registrant. The registrant has the option to inspect the references in a non-confidential file.

Confidential references are those which the registrant has waived the right to see.

Please consider the following in making a decision to have confidential or non-confidential references.

1. School officials prefer to see confidential references, believing the references are more frank in such credentials. The limited number of studies which have been made of confidential vs. non-confidential references Indicate a preference of both hiring officials and college faculty for confidential or enclosed references.

2. Registrants should be most selective in asking persons to write references for them. The persons selected should know the registrant well and be able to state facts and competencies of the registrant.

3. Writers of references will be informed at the time of writing that the reference is confidential or that the registrant will be permitted to see the reference.

I Have Elected:*

A Confidential File
A Non-Confidential FIle

By execution of the application, I do hereby authorize Crowder College or it’s representatives to verify all information contained within this application, and do waive any privilege I may have as to confidentiality to Crowder College or it’s representatives, and I do authorize any agency – – educational, health, or law enforcement – – to furnish to Crowder College or it’s representatives the information necessary to validate the information contained upon my veterinary technology application.

Signature*

Type in full name to sign and affirm this application

Date Signed