Companion Animal Shelter Medicine Externship Application

Please complete the following form. Click on the 'Submit' button to send the application to PAWS. Items marked with an * are required.

Applicant Information

First Name *

Last Name *

Street Address 1 *

Street Address 2

City *

State *

ZIP *

Home Phone *

Work Phone

E-mail *

Best Method to Reach You *

Best Method to Reach You

Home Phone

Work Phone

E-mail

Best Time(s) to Reach You *

Date of Birth *

Emergency Contact Information

Emergency Contact Name *

Phone *

Relationship *

Education and Experience

Veterinary School You are Attending *

Expected Graduation Date

Level of education (Freshman, Grad-Student, etc.)

Advisor's Name

Advisor's Phone Number

Skills Relevant to this Position *

Externship Information

Dates Available (List your 1st, 2nd and 3rd choices of date ranges.)

1st Choice *

2nd Choice *

3rd Choice *

List and explain any medical conditions that would prevent you from performing any aspect of the externship.

How did you learn about this externship? *

By submitting this form, I agree that the information provided is accurate to the best of my knowledge.

Security Code

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Contact Information

* denotes a required field

E-mail Address*

First Name*

Last Name*

Address

Address (line 2)

City

State/Province

Zip/Postal Code

Phone

Which regular PAWS Newsletters would you like to receive?

Please check all that apply

People Helping Animals (Monthly)

Actionline (Regularly)

Wild Again (Monthly)

Kids Helping Animals

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