University of California, Davis
Application for 2013-2014 Internship Program

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Application Instructions

If the program you are applying to is participating in VIRMP and this application is required, only this completed form should
be sent to the institution. Please complete, scan, and email to: dcgomez@ucdavis.edu

 

Instructions for programs not participating in VIRMP are below.

NOTE TO FOREIGN NATIONALS: The only visa available for VMTH House Officers is J-1; therefore you must be eligible for J-1 with no bars or home country requirements.

  1. Complete all information requested on this application.
  2. Arrange to have an official transcript of your professional (veterinary) coursework sent to the House Officer Program Coordinator to the address below. (If from a foreign school, you must provide an official English translation).
  3. A Curriculum Vitae is required.
  4. Letter of Intent: Attach separate sheets on which you describe your professional goals and what you expect from an internship.
  5. Request references from at least three sources (written in English) but not more than four, two of whom must be your clinical instructors or mentors. We will not initiate requests for references. (Letters written on letterhead and with signature, may be sent via email to dcgomez@ucdavis.edu).
  6. This application is for programs not participating in VIRMP, send application and all supporting materials to:

    House Officer Program Coordinator
    Veterinary Medical Teaching Hospital
    University of California, Davis
    One Garrod Drive
    Davis, California 95616-8747

    or by email to:

    dcgomez@ucdavis.edu

    7.  

  7. The large animal ultrasound fellowship and equine emergency internship ARE NOT administered through the Veterinary Internship Residency Matching Program (VIRMP). Therefore, it is not necessary to submit the VIRMP materials.

 

 

 

Application
(Complete application online, then print and email along with Letter of Intent and other requested documents)

 

The University of California, Davis and the Veterinary Medical Teaching Hospital are interested in candidates who are committed to the highest standards of scholarship and professional activities, and to the development of a campus climate that supports equality and diversity.

One copy of supporting documents must accompany each application form.

Program:

Application Date (MM/DD/YYYY):
Last (Family) Name:
First Name:
Middle Name(s)
Address

City:
State:
Postal Code:
Country:
Country of Citizenship:
E-Mail:
Telephone:
Cell Phone:
Fax:
School or Employment Address:
(Please limit input to 5 rows of 50 characters each.)
School or Employment Telephone:
School or Employment Fax:
   
       
Veterinary Education      
First Veterinary College
College Name and Address:
(Please limit input to 5 rows of 50 characters each.)
Dates of Attendance (MM/DD/YYYY):
 From:    To:
Degree(s) Obtained:
Graduation Date:
Grade Point Average:
Grade Point Scale (5.0, 4.0, etc):
Class Rank:
Class Size:

 

Second Veterinary College (if applicable)
College Name and Address:
(Please limit input to 5 rows of 50 characters each.)
Dates of Attendance (MM/DD/YYYY):
 From:    To:
Degree(s) Obtained:
Graduation Date:
Grade Point Average:
Grade Point Scale (5.0, 4.0, etc):
Class Rank:
Class Size:
   
Veterinary Practice Work Experience (since acceptance to veterinary school)

Employer's Name and Address:
(Please limit input to 5 rows of 50 characters each.)
Dates of Employment:
 From:    To:
Job Title and Duties:
(Please limit input to 5 rows of 50 characters each.)

Employer's Name and Address:
(Please limit input to 5 rows of 50 characters each.)
Dates of Employment:
 From:    To:
Job Title and Duties:
(Please limit input to 5 rows of 50 characters each.)

Employer's Name and Address:
(Please limit input to 5 rows of 50 characters each.)
Dates of Employment:
 From:    To:
Job Title and Duties:
(Please limit input to 5 rows of 50 characters each.)
       
Honors and Awards (related to veterinary medicine)
       
Special Interests (related to veterinary medicine)
       
References      
Reference 1
Name:
Address:
City, State, Postal Code, etc:
Title:
Work Phone:

Reference 2
Name:
Address:
City, State, Postal Code, etc:
Title:
Work Phone:

Reference 3
Name:
Address:
City, State, Postal Code, etc:
Title:
Work Phone:

Reference 4
Name:
Address:
City, State, Postal Code, etc:
Title:
Work Phone:
 
     
 
 
I hereby certify that these statements are true and correct to the best of my knowledge and that my misstatements will be cause for rejection of this application.
       
       
       
_____________________________________________________
______________________
Signature
Date