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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Note: Only PDF files are accepted.

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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

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 ACVO
ACVP ACVPM ACVR
ACVR/ONC ACVS ACVSMR
ACZM AVDC

Work Schedule

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
  • 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