MSU. Veterinary Technology Admission Packet. Morehead State University Veterinary Technology Program 25 MSU FARM DR. Morehead, KY

Transcription

1 MSU Veterinary Technology Admission Packet Morehead State University Veterinary Technology Program 25 MSU FARM DR. Morehead, KY

2 MOREHEAD STATE UNIVERSITY Department of Veterinary Technology (Please Print or Type Information Submitted) Associate of Applied Science Degree in Veterinary Technology & Bachelor of Science Degree in Veterinary Technology Please submit the following application materials directly to the Department of Veterinary Technology: 1. Completed Veterinary Technology Admission Application (Submission online is acceptable). 2. Completed HPCR Form 3. Completed Veterinary Experience Form 4. Current transcripts from MSU and any other universities/colleges attended. 5. Copy of course description(s) if course equivalencies are not listed on the transfer credit webpage located at 6. Copy of mid-term grades (if applicable). PLEASE NOTE that the items listed above MUST be forwarded with your application even if previously sent to this or any department or office within the University. For example, transcripts need to be submitted to BOTH the Department of Veterinary Technology and Admissions. Submit all application materials to: Morehead State University Department of Veterinary Technology Attn: Vet Tech Admissions 25 MSU Farm Dr. Morehead, KY 40351

3 Admission Application Morehead State University Department of Veterinary Technology ( ) Associate of Applied Science in Veterinary Technology ( ) Bachelor of Science in Veterinary Technology ( ) Undetermined 1. When do you plan on entering the above selected Veterinary Technology Program? (Semester/Year) 2. Full Legal Name: (Last) (First) (Middle) 3. Address: (Street/Route) (City) (State) (Zip) 4. MSU ID #: 5. Phone Number:(Home) (Cell) 6. Address: 7. Name & Phone of person to contact in case of emergency: Work Phone: Home Phone: 8. Date of High School Graduation: (Month/Year) Name of School: 9. Are you now or have you previously attended college/university (including Morehead State University)? Y N If yes, give name, years attended, and number of credit hours attempted: a. Currently attending? Y N b. Currently attending? Y N

4 Morehead State University Veterinary Technology Program Health, Physical Capability, and Risk Assessment (HPCR) Applicant s Full Name: Date of Birth: SSN: The following is to be completed by a Licensed Medical Practitioner: Physical Capabilities Please Circle One Vision Capabilities: Applicant has normal or corrected refraction within ranges of 20/20 to 20/190? Yes No Applicant is able to distinguish color shade changes? Yes No Auditory Capabilities: Applicant possesses normal or corrected hearing ability within 0 to 45 decibel range? Yes No Tactile Capabilities: Applicant possesses in at least one hand the ability to perceive temperature change and pulsations and to differentiate between various textures and structures? Language Capabilities: Applicant possesses the ability to verbally communicate? Yes No Motor Capabilities: Applicant possesses 4 functional limbs (normal or artificial)? Yes No Applicant can grasp securely with at least one hand? Yes No Applicant can stand for long periods of time? Yes No Applicant can walk unassisted? Yes No Yes No Statement of Licensed Medical Practitioner: Name of Practitioner: Office Address: I hereby certify that the above named applicant has been examined by me on this date and meets or exceeds the physical capability requirements stated above. I have also reviewed the VT occupational hazards with them and feel that they understand the associated risks. Signature: Date: Statement of Applicant: I have reviewed the VT occupational hazards with my medical practitioner and understand the associated risks. If I become aware that I have an increased risk of injury from an occupational hazard, I will seek the advice of my medical practitioner immediately and institute appropriate precautionary measures under their guidance. Signature: Date: ATTACH DOCUMENTATION OF TETANUS AND RABIES IMMUNIZATIONS.

5 Morehead State University Veterinary Technology Program Applicant Evaluation/Recommendation Form To be completed by the applicants veterinary experience provider. Applicants Name: How long have you known the applicant? Was the applicant a paid employee or volunteer? In what capacity did the applicant serve you? (kennels, vet assist, front desk, observer) How long did the applicant serve you? (min 120hrs) Species: Excellent Above Average Dog Cat Horse Cattle Sheep/Goat Pig Exotics Area: Attendance Punctuality Personality Professional Skills Productivity Personal Appearance Dependability Cooperation Professional Attitude Scholarship Teamwork Overall: Comments: Please evaluate the applicant s aptitude in each category Average Below Average Poor N/A I hereby verify that the applicant has assisted or observed within my practice as indicated above. Name: Title: Address: Clinic Name: Signature: Date:

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