Externship Award application Externship Award Application ApplicantExternship awards are available to students who are completing a shelter medicine and/or spay/neuter externship during 2021. Only externships at agencies outside of Alachua County are eligible for expense reimbursement awards. Awards are distributed as reimbursements. Please review this document to understand qualifying expenditures and required documentation. Questions regarding reimbursements can be sent to Michelle Laramie at mlaramie@ufl.edu.Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the best mailing address to use for reimbursements. Email* UF ID*CVM Class*Are you enrolled in the Shelter Medicine Certificate?* Yes No What type of Externship do you wish to apply your award to?* Shelter Medicine Spay/Neuter Shelter Medicine ExternshipsShelter Medicine AgencyPlease choose an agency from the approved list. *If the agency is not currently on the approved list contact Naima Cortes-Stoneberger for further details prior to submitting this application, ncortes@ufl.edu. Address of Shelter Street Address Shelter Name City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the address of the shelter where you will be doing your externshipShelter Medicine Externship DatesSpay/Neuter ExternshipsSpay/Neuter AgencyPlease choose an agency from the approved list. *If the agency is not currently on the approved list contact Naima Cortes-Stonberger for further details prior to submitting this application, ncortes@ufl.edu.Address of Shelter Street Address Shelter Name City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please provide the address of the shelter where you will be doing your externshipSpay/Neuter Externship DatesMaterialsStatement of Purpose or Essay*Please enter a statement of purpose (no more than 300 words) explaining your reasons for completing your chosen externship(s) and how this will benefit your career plans. Resume or CV*Please upload current resume of CV file which should include employment, education, and involvement in animal welfare related activities. Waiver* I understand that by checking this box and submitting this application I am authorizing Maddie’s Shelter Medicine Program to utilize my likeness, statement of purpose, and comments/reports to promote and publicize the Shelter Medicine and Certificate Program. Agreement* If chosen for this award, I agree to submit a thank you letter for the donor as well as photos, at the conclusion of my externship experience. Please select "complete" or "pending" for the following courses and elective activities. VEM5321: Integrating Vet Med w/ Shelter Systems Complete Pending N/A VEM5320: Shelter Animal Behavior & Welfare Complete Pending N/A VEM5381: Shelter Animal Physical Health Complete Pending N/A VEM5864: Sterilization/Population Management Clerkship Complete Pending N/A VEM5891: Veterinary Community Outreach Program Complete Pending N/A VEM5890: Consultations in Shelter Animal Medicine Clerkship Complete Pending N/A VEM5061: Introduction to Veterinary Disaster Response Complete Pending N/A VEM5324: Veterinary Forensic Medicine Complete Pending N/A Operation Catnip Complete Pending N/A SCASV Complete Pending N/A Please forward any questions to Naima Cortes-Stoneberger at ncortes@ufl.edu.
