ECVP resident registration form

Resident Registration Form

(to be submitted by the programme director)
Personal information:
Name*

First Name(s)Last Name(s)
E-mail address*
Faculty/school of graduation*
Month/year of graduation in veterinary medicine*
Country/year of autorization to practise veterinary medicine *
Training information:
Date (day/ month / year) of start of residency training programme*

DayMonthYear
Date
Training centre/workplace*
If other please specify the name of the workplace
Address*
ZIP-Code / City
Country*
Additional information:
Name of the supervisor*
Full Name
E-mail address of the supervisor*
example@example.com
Name of the programme director*
Full Name
E-mail address of the programme director*
example@example.com
ECVP-registered residency training centre*
Programme type*

Standard training programmeAlternative training programme
If you select the alternative training programme, please choose your training plan

Individual planModular credit system
*** If you select an Alternative training programme, please attach the following support documents to the form:

a) an outline of the planned training programme prepared and signed by the candidate and the sponsor
b) a support letter from the sponsor, who must be an ECVP Diplomate or an ACVP Diplomate based at an ECVP-registered residency training centre. By this letter, the sponsor agrees to be responsible for the resident's application to the examination.
Support documents for the alternative training programme

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In order to commence a 3-year residency training in veterinary pathology, the candidate must have completed an “internship” (i.e. have worked or undergone training as a veterinarian in a field relevant to veterinary pathology) for at least 1 year (12 months) subsequent to graduation from veterinary school.
Internship: Please provide a brief summary and dates of the resident's work experience since graduation (copy and paste from a document is available in this field) *
* Internship and work experience example:

10/12/2018 – 31/12/2019 Internship (minimum of 12 months) 'Name of the workplace', 'Type of the Position', 'Description of duties'

01/01/2020 – present: Other work experience 'Name of the workplace', 'Type of the Position', 'Description of duties'
Should be Empty:

Resident Registration Form