Partner application form

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Location and contact information

Organization*

Website*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Number of current staff

Number of veterinarians*

Number of CVTs*

Number of assistants and other staff*

Practice manager*

Yes

Hours of operation

Monday*

Tuesday*

Wednesday*

Thursday*

Friday*

Saturday*

Sunday*

Emergency hours*

Facility details

How would you classify your facility?*

Companion practice

Food animal practice

Research

Emergency

Mixed animal practice

Equine practice

Shelter

Referral, specialty, or other

What animals are seen at your facility*

Dogs

Cats

Rodents

Cattle

Horses

Birds

Reptiles

Swine

Sheep

Goats

Other

Referral, specialty, or other*

Other (please specify)*

Is free parking available at your site?*

Yes

Is public transportation to your site available?*

Yes

Who will be С��è��ý's primary contact for your facility?*

Who will be supervising the student(s)?*

Do you have an existing training program for new CVTs?*

Yes

Please describe in as much detail as possible what the Student Veterinary Technician’s learning experience at your site will be like*

Diagnostic imaging

The use of personal protective equipment such as lead shields, thyroid shields, and lead-lined gloves is required. С��è��ý provides student dosimetry badges.

Check all that apply*

Radiography

Digital radiography

Dental radiography

Digital dental radiography

Automatic processor

Ultrasonography

Endoscopy

Other

Other (please specify)*

Surgery

Check all that apply*

Laser surgery

AHAA Certified

Steam autoclave

Gas sterilization

Ultrasonic dental scaler

Dental unit

Other

Other (please specify)*

Please describe surgeries typically performed at this facility*

Laboratory equipment

Check all that apply*

Blood gas analyzer

Blood chemistry

Microscopy

Gram stain

Cytology

Centrifuge

Tonometry

CBC analyzer

Other

Other (please specify)*

What percent of lab work is typically sent to a commercial laboratory vs. being performed in-house?*

Anesthesia

Inhalation gases typically used*

Nitrous oxide

Sevoflurane

Isoflurane

Halothane

Other

Other (please speficy)*

Injectable agents typically used*

Propofol

Ketamine/Valium

Domitor/Antisedan

Xylazine/Yohimbine

Opioids

Barbiturates

Other

Other (please specify)*

Monitoring equipment*

Pulse oximeter

ECG

Blood pressure monitor

IV fluid pump

Ventilator

Other

Other (please specify)*

Procedures

At your facility, what procedures do technicians typically do?*

Admit patients

Make appointments

Client education

Examine patients

Discharge patients

Prep for surgery

Administer anesthetic

Cytology

Place IV catheters

Monitor anesthesia

U/A

Prepare prescriptions

Blood chemistry

Fecal analysis

Intubate surgical cases

Perform dental cleaning

Draw blood

Obtain other biological samples

Administer injectable medication

Take radiographs

Restrain animals

Other

Other (please specify)*

Please describe other technician responsibilities*

Agreement and guidelines

As a С��è��ý Veterinary Technology Cooperative Education Partner, you agree to the following guidelines*

Provide a clinical training site by:
- Preparing staff to welcome the student as a member of the team.
- Providing structure and direction for the student.
- Utilizing new employee training procedures regarding policies and procedures such as dress code and sick days.
Supervise the student by
- Identifying who on staff will guide the student, assign dailytasks, schedule lunches, breaks and do the student’s performanceevaluation.
- Giving the student direction on daily activities.
Promote and support the student by:
- Providing feedback and positive reinforcement for work well done.
- Being willing to meet and talk with the student on a regular basis regarding their performance.
- Recognizing problem areas with students, provide direction to resolve conflict or disagreement.
- Contacting the С��è��ý Co-operative Education Coordinator for training and problem-solving support.
Instruct the student by:
- Identifying procedures the student has been taught, and help them gain confidence and competency by giving them opportunities to practice these procedures, both with help and then independently.
- Teaching the student new skills specific to your site, and give them opportunities to practice with supervision and then independently.
- Answering the student's questions whenever possible.
Abide by all Oregon Veterinary Medical laws and regulations.

I agree to the Cooperative Education guidelines

Captcha

This form is protected by reCAPTCHA. The Google and apply.