STUDENT INFORMATION

  Name:

  Address:

  City, State & Zip:

  Phone (including Area Code):

  Email address:

  Veterinary college attending or admitted to:

  Class:

  Prior experience with food-producing animals (may also be included in your letter of intent):

EXTERNSHIP INFORMATION:

  Name of clinic/facility/veterinarian:

  Address:

  City, State & Zip:

  Phone:

  Fax:

  Email address:

  Name(s) of veterinarian(s) in practice who are AABP members.

  What percentage of practice activity is devoted to bovines?

  Food animals?

  Proposed externship dates:

  Where will the student live during the externship?

  Will the student be paid?

  Will room and/or board be provided?

  EXPENSES FOR PROPOSED EXTERNSHIP

  Transportation (Specify whether air, train, or car):

  Room:

  Board and living expenses:

  Lost wages: (provide evidence that you actually would be earning these wages, for example, a recent pay check stub or W-2)

  Other expenses:

  Total expenses:

  Total aid requested:

APPLICATION DEADLINE: October 1, 2007 for externships commencing between November1, 2007 and April 30, 2007.

  YOUR APPLICATION MUST INCLUDE: 1. This completed form. 2. A letter of intent describing your career interests, prior experience with food-producing animals, and goals for the externship. 3. A letter from the practice describing what you will be doing, stating what the housing arrangements will be, and attesting that you will be covered under the practice's professional liability and workmen's compensation insurance. 4. A letter from a faculty member at your veterinary college (or preveterinary instructor, in the case of incoming freshmen), with an assessment of your demonstrated interest in food animal practice. 5. A completed Release Agreement.

  INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED OR RETURNED.