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Veterinary Medicine Licensure Application - Massachusetts Division Of Professional Licensure Page 12

APPLICATION CHECKLIST

YOU MUST INCLUDE THIS COMPLETED DOCUMENT WITH YOUR APPLICATION

□□□-□□-□□□□

MY SOCIAL SECURITY NUMBER 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 with 2” x 2” passport-style photo.

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NON-REFUNDABLE fee of $343.00 (check or money order payable to the “Comm. of MA”).

Please note that this amount includes the application fee ($272.00), plus the initial license fee ($71.00).

□

Completed Jurisprudence Exam. Contact Board office at 617-727-5899 or

use the

“Email the

Board” link on the Division of Professional Licensure’s website

( ) to request an exam.

□

Confirmation of degree. (If applying to take NAVLE: Item 8 on application (certified

statement by Dean/Registrar) must be completed. When applying for licensure: An official, sealed

transcript confirming degree must be submitted.)

□

Two completed Professional and Ethical Reference Forms from currently licensed

veterinarians (must remain in sealed envelopes with back of envelope signed along the seal)

□

(If applicable) Graduates from non-AVMA accredited schools must provide

documentation of enrollment/completion in the Educational Commission for Foreign Veterinary

Graduates (ECFVG) or the PAVE. To sit for exam, the Board requires verification of enrollment in

ECFVG or PAVE and transcript. For licensure, applicant must submit proof of completion of the

ECFVG or PAVE and transcript.

□

(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.

□

Criminal Offender Record Information (CORI) Acknowledgment Form

IF APPLYING FOR ATEMPORARY PERMIT:

□

Completed Temporary Permit Application 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 the Board staff at (617)

“Email the

Board” link on the Division of Professional Licensure’s website

727-5899 or via

( ).

Please mail your completed materials to:

Board of Registration in Veterinary Medicine

1000 Washington Street, Suite 710

Boston, MA 02118-6100

Veterinary Medicine Licensure Application - Massachusetts Division Of Professional Licensure Page 12

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