Short-term Clinical Placements at U-Vet

Short-term Clinical Placements at U-Vet

Fill out the below form carefully for your own request - do not apply on behalf of other students.
Student Name *

First Name Middle Name Last Name
Student E-mail *

Confirmation Email

Home Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mobile Number

Area Code Phone Number
Phone Number *

Area Code Phone Number
Institution Name *
Country this Institution is located in? *
Course *
Expected date of completion. *

Month Day Year Date Picker Icon
We will try to match you to your section of interest but we may not be able to depending on availability.

Please order the below sections in order of preference from 1 to 9.
*
Clincal placements can be either two weeks or four weeks long - please select your preferred options using the calendars below. Please note that placements are not available in January.
Please select a starting date for your First Preference *

Day Month Year
Date Date Picker Icon
Please indicate a duration for your First Preference *

Two week placement Four week placement
Please select a starting date for your Second Preference *

Day Month Year
Date Date Picker Icon
Please indicate a duration for your Second Preference *

Two week placement Four week placement
Please select a starting date for your Third Preference *

Day Month Year
Date Date Picker Icon
Please indicate a duration for your Third Preference *

Two week placement Four week placement
English Requirements - If you have met the University's English language requirement please provide your score and attach supporting documentation. *
Supporting Documentation *
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