Veterinary Medicine Licensure Application - Massachusetts Division Of Professional Licensure Page 12
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12Applicant’s Checklist/Requirements for Licensure
YOU MUST INCLUDE THIS WITH YOUR APPLICATION
MANDATORY
□□□-□□-□□□□
MY SOCIAL SECURITYNUMBER IS
:
Pursuant to G.L. c. 62C, s. 47A, the Division of Professional Licensure is required to obtain your social security number
and forward it to the Department of Revenue. The Department of Revenue will use your social security number to
ascertain whether you are in compliance with the tax laws of the Commonwealth."
PLEASE CHECK EACH BOX
:
□
Completed application w/ photo
□
NON-REFUNDABLE Fee of $272.00 (check or money order payable to the “Comm. of MA”.)
□
Completed Jurisprudence Exam (contact Board office at 617 727-3080 or
leija.t.meadows@state.ma.us
to obtain exam)
□
Confirmation of degree. (If applying to take NAVLE, Item 8 on application “certified statement
from the Dean” must be completed; When applying for licensure: Official sealed transcript of
conferred degree or NOTARIZED copy of diploma must be submitted)
□
Two completed Professional and Ethical Reference Forms from licensed veterinarians (must
remain in sealed envelopes with back of envelope signed along the seal)
□
(If applicable) Graduates from non-AVMA accredited Universities must provide
documentation of enrollment in the Educational Commission for Foreign Veterinary
Graduates (ECFVG) or the PAVE program. Certification from graduates of foreign
veterinary schools (to sit for exam, the Board requires verification of enrollment in
ECFVG or PAVE program and copy of veterinary diploma and transcript. For
licensure, applicant must submit proof of completion of the ECFVG or PAVE programs)
□
(If applicable) Exam scores from Veterinary Information Verifying Agency (VIVA)
□
If you have/had a license in another state or foreign jurisdiction, sealed verification from each is
required.
IF APPLYING FOR TEMPORARY PERMIT
□
Completed Temporary License Form with signatures of all supervisors.***
***Upon receipt of the application, you will be notified of a scheduled interview with the Board. Board
interviews are required in order to receive a temporary permit. At least one supervisor must
accompany you to this interview. Interviews are held the second Thursday of each month, unless
otherwise noted
Should you have any questions about the application process, please contact Board Staff, at (617)
727-3080 or via email Diane.m.Savickas@state.ma.us.
Board of Registration in Veterinary Medicine
Mail your materials to:
1000 Washington Street, Suite 710, Boston, MA 02118-6100
Updated 2/2015
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