Externship Award Application Maddie’s® Shelter Medicine Externship Applications can be submitted now through January 15, 2016. Edu: Application- 2016 Shelter Medicine Externship Application ApplicantName First Last Email CVM Class*2016201720182019Are you enrolled in the Shelter Medicine Certificate?* Yes No Not sure AgenciesScheduled or Estimated Externship DatesI have already scheduled an externship with the following agency: (OR see next question)I plan to schedule an externship with the following agency:MaterialsStatement of Purpose*Please enter a 250-word Statement of Purpose that explains your reasons for completing a Shelter Medicine externship and how a Shelter Medicine externship will benefit your career plans. Resume or CV*Please upload a current resume or CV. Photo*Please upload a photo of yourself with a pet. Unofficial Transcript*Please upload an unofficial transcript. 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.