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Sample Internship Submission Form

View Residency Form

Thank you for your interest in the VIRMP. Starting with the 2024 VIRMP, the VIRMP launched a new form to gather important information from programs. This form is made available to you as an example of what will be requested. This form is subject to change each year.

General Information

Max 100 words
Youtube and Vimeo URLs are supported
Enter each satellite work site, if any

Employment

Numeric Amounts Only
Numeric Amounts Only
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e.g. 5 miles / 10 minutes
Include time & distance
Numeric Amounts Only
check all that apply
check all that apply
If available

Benefits

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Medical Benefits

Leave

Whole Numbers Only
Whole Numbers Only
Whole Numbers Only
Whole Numbers Only
Whole Numbers Only

Other Benefits

Caseload in Direct Support of Program

Report each caseload figure as a whole number, never a range. Details the structured fields cannot capture such as species mix, seasonal variation, or alternate program structure should be included in Additional Details about Caseload below.

The Average Daily caseload numbers are based on the number of workdays per year. If the yearly caseload is seen 5 days per week, divide by 260. If the yearly caseload is seen 7 days per week, such as emergency services/ECC, divide by 365. Round each to the nearest whole number.

Report each caseload figure as a whole number, never a range. Details the structured fields cannot capture such as species mix, seasonal variation, or alternate program structure should be included in Additional Details about Caseload below.

The Average Daily caseload numbers are based on the number of workdays per year. If the yearly caseload is seen 5 days per week, divide by 260. If the yearly caseload is seen 7 days per week, such as emergency services/ECC, divide by 365. Round each to the nearest whole number.

Number of patients presented to the hospital annually. Include only the patients presented to the hospital(s) (small animal, large animal, equine, all) to which the intern will be assigned. Support services (radiology, anesthesia, and similar) typically serve all hospitals so the combined caseload (all hospitals) should be counted.
Number of outpatients seen by the hospital(s) to which the intern will be assigned, divided by the number of workdays.
Number of inpatients seen by the hospital(s) to which the intern will be assigned, divided by the number of days the hospital is responsible for care. Most hospitals have inpatients 24/7 therefore divide the inpatient caseload by 365 days.
Number of surgical procedures performed in the hospital(s) to which the intern will be assigned, divided by the number of workdays.
Number of emergencies seen by the hospital(s) to which the intern will be assigned, divided by the number of days per week emergencies are received (typically 365 days).
Use this space for anything the numbers above do not capture: species mix, seasonal variation, or alternate program structure. See the definitions page for illustrative examples.

Personnel

Direct Support - Personnel are in the building and available to the intern. If the intern works with both large and small animals, please include diplomates in large and small animal.
Full-Time Part-Time
Consultant		 Full-Time Part-Time
Consultant		 Full-Time Part-Time
Consultant
ABVP ABVT ACLAM
ACPV ACT ACVAA
ACVB ACVCP ACVD
ACVECC ACVIM/CARD ACVIM/INTMED
ACVIM/LA ACVIM/NEUR ACVIM/NUTRITION
ACVIM/ONC ACVM ACVNU
ACVO ACVP ACVPM
ACVR ACVR/ONC ACVS
ACVSMR ACZM AVDC

Work Schedule

Choose the unit that best matches how your program plans each assignment — no unit is preferred. Enter 0 for anything your program doesn't schedule; a zero needs no unit.

Including patient care, on-call, night float, research, conferences, etc
Excluding on-call

Rotations

Enter the number of weeks for each rotation below even if 0.

Rotation Required
# of Weeks		 Rotation Required
# of Weeks		 Rotation Required
# of Weeks
Ambulatory Anesthesia Avian/Exotics/Zoo
Cardiology Clinical Pathology Day Emergency
Dentistry Dermatology General Surgery
Intensive/Critical Care Internal Medicine Neurology
Oncology Ophthalmology Orthopedic
Overnight Emergency Radiology Soft Tissue
Urgent Care

Clinical Experience and Responsibilities

%
%

Didactic Training

Educational Benefits

Facility

Available on-site

Outcomes

Interviews

Scheduled interview dates, if available

Other Program Requirements

All programs receive the standard VIRMP Application Packet that consists of:

  • Special Disciplinary Interest
  • Current Position
  • Publications, research or other pertinent experience
  • Post-DVM Training Programs Completed
  • North American Veterinary Licensing Examination® Status
  • Career Interest
  • Work Authorization
  • CV
  • Personal Statement
    Prompt: Please provide a personal statement discussing your expectations of an internship program and your future professional goals. In addition, we encourage you to describe your anticipated contributions to your matched institution. These may include life experiences, background, past activities or unique personal characteristics that would contribute to the program in meaningful ways.
  • Veterinary College Transcripts (DVM & Post-DVM)
  • References
    Applicants must submit a minimum of 3 references with a maximum of 4 references.
    Guidance: We recommend professors, instructors and others who have had close professional contact with you and are aware of your veterinary knowledge and performance in veterinary college.
If undergraduate transcripts are only required if the applicant is matched, you should select 'No' and state transcript requirements in the 'Other Program Requirements' box below.

Additional Information