Looking for a Veterinary License Application Form Templates? Download it for free!

Veterinary Medicine Licensure Application - Massachusetts Division Of Professional Licensure Page 11

The Commonwealth of Massachusetts

Division of Professional Licensure

Board of Registration in Veterinary Medicine

1000 Washington Street, Suite 710

Boston, MA 02118-6100

(617) 727-5899

TEMPORARY PERMIT APPLICATION

TO BE COMPLETED ONLY IF REQUESTING A TEMPORARY PERMIT TO PRACTICE

GRADUATES OF NON-AVMA ACCREDITED VETERINARY SCHOOLS ONLY

To be eligible for a temporary permit, a candidate must have passed the Board’s Jurisprudence Examination and

the North American Veterinary Licensing Examination (NAVLE) AND be within six (6) months of completing

the ECFVG or PAVE. You must provide either an ECFVG or PAVE status report as proof that you meet this

time requirement.

A Board interview of the candidate and supervisor is required. If approved, a temporary permit is valid for six

months, with the possibility of just one renewal for an additional six months. Under no circumstances will a

temporary permit be valid over twelve months.

Graduates of AVMA Accredited Veterinary Schools are not eligible for a temporary permit.

To be completed by candidate and supervisor(s)

Candidate Name: _______________________________________________________________________

Please Print

Signature

Date

If the facility is a multi-veterinarian practice, the Board suggests that all veterinarians that this candidate may be

supervised by sign this form. Please use the back of this form if additional space is needed.

Supervisor_____________________________________________________________________________

Please Print

License No.

Signature

Supervisor_____________________________________________________________________________

Please Print

License No.

Signature

Supervisor_____________________________________________________________________________

Please Print

License No.

Signature

Practice address & telephone number

______________________________________________________________________________________

VT App September 2017

Veterinary Medicine Licensure Application - Massachusetts Division Of Professional Licensure Page 11