Approval Form For Elective (Externship) Off-Campus Rotation


Requests Are Not Approved Retrospectively

All fields are required.

Externship's Name/Address/Website (Complete address)

Extra Information

Do you plan to drop an existing scheduled elective:
Number of days you will spend with the veterinarian:
Number of total hours you will spend with the veterinarian:
Number of credits you are requesting for this experience:
If your total elective credits exceed 11 with this experience, do you plan to pay for those credits exceeding the required 11?:
Area of emphasis for the externship (i.e. cow/calf, feedlot, surgery, exotics):
Does this externship count towards the Food Animal Veterinary Certificate?

Summarize what you will be doing (What knowledge do you hope to gain?):

Justification (Why did you select this externship site?):

How does this fit your future plans (Minimum of 4-5 sentences)?

Additional Information:

Name of the doctor who will serve as evaluator (please list credentials):
E-mail (Use supervisor's e-mail only):
KSU CVM Radiation Safety Badge Protocol

If you do not receive notification within two weeks, please contact Kate Drew at