VMTH Residency Program Application

University of California, Davis
Application for 2009-2010 VMTH Residency Program
(This page best viewed at 1024X768 resolution)

Application Instructions

Complete all information requested on this application.
Arrange to have an official transcript of your professional (veterinary) coursework sent to the Resident Affairs Coordinator. (If from a foreign school, please provide an English translation).
A Curriculum Vitae is required.
Request references from at least three sources (written in English) but not more than four, two of whom must be your clinical instructors. We will not initiate requests for references.

THE DEADLINE FOR RECEIPT OF APPLICATION MATERIALS IS DECEMBER 1, 2008 except for the following programs: Radiology (November 21, 2008). Ophthalmology (November 3, 2008). Lab Animal/Primate Medicine (October 15, 2008). CAHFS (see website). Mail the residency application and all supporting application materials to:

VMTH Residencies	CAHFS Residencies*
Resident Affairs Coordinator Veterinary Medical Teaching Hospital University of California, Davis One Shields Avenue Davis, California 95616-8747 Voice: (530) 752-2957 FAX: (530) 752-3314 Please write the name of the program you are applying to on the outside of the envelope on all correspondence.	Administrative Office California Animal Health & Food Safety School of Veterinary Medicine Davis, CA 95616 Voice: (530) 752-8709 Fax: (530) 752-5680

In conjuction with this application, you must also apply to the Veterinary Internship Residency Matching Program (VIRMP)** the nationwide computer matching service sponsored by the American Association of Veterinary Clinicians for programs participating in the VIRMP. ALL APPLICANTS THAT ADHERE TO THE GUIDELINES OF THE RESIDENCY MATCHING PROGRAM WILL BE CONSIDERED. THE GENERAL VIRMP RESIDENT APPLICATION FORM IS NOT REQUIRED AS PART OF YOUR UCDAVIS PACKET.
The beginning date of each program is August 1, 2009 with the exception of Laboratory Animal/Primate Medicine which begins July 1, 2009.

** Anesthesia, Behavior, Clinical Pathology, Dairy Production Medicine, Lab Animal/Primate Medicine, Ophthalmology, and Radiology do not participate in the matching program.

Please consult the detailed residency description for further information regarding each program.

Application
(complete application online then print and mail along with Letter of Intent and other requested documents)

Program

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.

If applying for more than one program, submit a separate and complete application for each program. One copy of supporting documents must accompany each application form. Applications will not be processed unless one of the programs listed below is selected. Numbers in parentheses indicate number of positions available.

Application Date (MM/DD/YYYY):
Social Security Number (XXX-XX-XXXX):
VIRMP Account Number:
E-Mail address used when registering for VIRMP:
Last (Family) Name:
First Name:
Middle Name(s)
Address:

City:
State:
Postal Code:
Country:
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:	(All phone numbers must be applicable from December - March)

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.)	Current or most recent position
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.)	2nd most recent position
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.)	3rd most recent position
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:

Letter of Intent

Attach separate sheets on which you describe your professional goals and what you expect from a residency.

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