Externship Application - Rogue Equine & Companion Animal Clinic

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Todays Date?*

Applicant Full Name*

Given Name Surname 1 Surname 2

For foreign students, do you possess a valid VISA to enter the United States, if required?*

Yes
No

Mailing Address - Home*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone Number*

Email

Are you currently a student enrolled in a program at university studying veterinary medicine?*

I am not yet in veterinary school
I am in my first year of veterinary school
I am in my second year of veterinary school
I am in my third year of veterinary school.
I am in my fourth year of veterinary school
I am in my final year and will finish with a degree in veterinary medicine.
I have finished veterinary school.

Do you have an interest in equine medicine, surgery and reproduction or small animal medicine and surgery?*

Equine Medicine
Small Animal Medicine
Both

Please list in order of preference up to three specific interests within the category listed.

Do you have health insurance - in case of sickness or injury, unrelated to an externship?*

Days available: As a clinic/hospital, we operate 7 days per week. Do you agree to be available every day of the week?*

Yes
No

Holidays available: As a clinic/hospital, we operate 7 days per week. Do you agree to be available holidays, if asked or needed?*

Yes
No

Hours available: As a clinic/hospital, we operate 24 hours per day. Do you agree to be available more than 8 hours per day and overnight?*

Yes
No

Are you able to lift 50 lbs routinely and regularly?*

Yes
No

If you are not able to lift 50 lbs, please explain below. Otherwise mark as N/A*

Are you able to work under hot climate conditions (over 100 degrees) or cold (below freezing)?*

Yes
No

Are you able to work under conditions of high or low humidity?*

Yes
No

If you answered no to any of the two climate questions above, please explain. Otherwise mark as N/A.*

First available date?*

Preferred finish date?*

Please list your licenses, training, awards and relevant skills.*

Final two questions! Please list three things you would like to learn or experience while at an externship*

Please tell us what believe you can contribute to an externship program. This can be a personal, medical or social answer.*

Applicants Statement*

I agree to the below statement:

APPLICANT’S STATEMENT:
I understand this is an unpaid externship, however a weekly stipend may be offered to offset daily expenses. While not guaranteed, some reimbursement may be offered to offset travel expense. Generally, accommodation (room on site) is offered.
Limited time away from externship duties are accepted under prior arrangement.

Date of signing*

Applicants Signature*

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for compassionate, personalized, expert veterinary medical care
serving Southern Oregon and Northern California.

Externship Application Form - Secure