Mount Ida College

From Potential to Achievement

Mount Ida College Internship Program Site Approval Request Form

MOUNT IDA COLLEGE
INTERNSHIP PROGRAM
SITE APPROVAL REQUEST FORM

IN ORDER TO BE CONSIDERED FOR APPROVAL AS A MOUNT IDA COLLEGE INTERNSHIP SITE, PLEASE COMPLETE AND RETURN THIS FORM. IF APPROVED, THIS FORM WILL BE INCLUDED IN THE INTERNSHIP PROGRAM FILE. IN ORDER TO BE APPROVED THE SITE MUST EMPLOY AT LEAST ONE VETERINARY TECHNICIAN WHO IS A GRADUATE OF AN A.V.M.A. ACCREDITED VET TECH PROGRAM. TO REQUEST AN EXEMPTION TO THIS REQUIREMENT, PLEASE ATTACH A SEPARATE PAGE STATING WHY YOUR FACILITY DOES NOT EMPLOY A VET TECH.

* Required fields are indicated in red with a star.

* Name of Facility
* Supervisor's Name
* Date
* Title of Supervisor (Supervisor must be a graduate of an A.V.M.A. accredited vet tech program)
* Supervisor's Email Address
* College Attended by Supervisor
* Degree Earned
* Facility Description (Small Animal Practice, Research Facility, Equine Practice, University, Zoo, Wildlife Clinic, Aquarium, Ophthamology Specialty, Sx Specialty, Ultrasound...be as specific as you can)
* Address of Facility
* Phone Number of Facility
* Email/Web Address of Facility
* Fax Number
* Number of Full-Time Veterinary Technicians (include only A.V.M.A. accredited program graduates)
* Number of Part-Time Vet Techs
* Number of Full-Time Veterinarians
* Number of Part-Time Veterinarians
* Number of Other Full-Time Employees
* Titles of Other Full-Time Employees
* Number of Part-Time Employees
* General Responsibilities of the Internship Student
* Do You Require an Interview?
* How far in advance would you like to know that a student has selected your site for an internship?
* Please list any requirements which the student must fulfill prior to their participation at your site (ex: TB Test, Rabies Vaccine, uniform requirement).
* Please list any articles or books which the student must read or obtain prior to their participation at your site
* How do you feel a student would benefit from completing an internship at this facility?
* Please use this space to provide us with any additional information about your site and the people who work here, including special interests, projects or activities which might be of interest to students as they continue their educational experience at your site.
* Please provide us with directions to your facility.
* E-mail
 

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