Form 08-609 - Application To Practice Veterinary Medicine Page 4
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14VET
State of Alaska
For Division Use Only
Department of Commerce, Community and Economic
Development Division of Corporations, Business and
Professional Licensing BOARD OF VETERINARY EXAMINERS
th
State Office Building, 333 Willoughby Avenue, 9
Floor
PO Box 110806, Juneau, AK 99811-0806
Phone: (907) 465-2550 Fax: (907) 465-2974
E-mail: license@alaska.gov
Website:
APPLICATION FOR VETERINARY LICENSE
Make check or money order payable to the State of Alaska.
Nonrefundable Application Fee:
$250.00
Temporary License Fee
$125.00
Initial License Fee:
$500.00
Wall Certificate (optional)
$20.00
State Written Examination Fee:
$200.00
I hereby apply for a license to practice veterinary medicine, surgery, and dentistry in the State of Alaska by:
Credentials
Examination
(If applying by examination, do you want a temporary license while awaiting examination results:
Yes
No)
If any section does not apply, write “NA” in the space provided.
Name:
Last
First
Middle Initial
Mailing Address:
Street or P.O. Box Number
City
State
Zip Code
Social Security No.:
Birth Date:
Gender:
Male
Female
Daytime Telephone Number:
Email:
Other Names under which you have been known (maiden name, etc.):
EXAMINATION INFORMATION:
YES
NO
Have you taken the North American Veterinary Licensing Examination?
If yes, scores must be sent directly to this office from the National Board Examination
Committee (NBEC) or Veterinary Information Verification Agency (VIVA).
If no, have you applied through the National Board of Veterinary Medical Examiners
(NBVME) to take the next scheduled NAVLE exam through Alaska?
(You must contact NBVME for an application, or you may obtain information from the
NBVME) website at
Have you taken the National Board Exam?
If yes, date taken:
State:
Have you taken the Clinical Competency Test?
If yes, date taken:
State:
EDUCATION:
School of Veterinary Medicine
Name and Location
Dates Attended
Diploma Received
Date of Diploma
08-609 (Rev. 09/23/16)
Application Page 1 of 3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Verification And Examination For Licensure To Practice Veterinary Medicine In Kentucky
Business
Form 08-4356 - Application To Upgrade The Tonnage Of A Deputy Marine Pilot License - Department Of Commerce And Economic Development
Legal
Form 08-4076 - Application To Change License Status - Department Of Commerce And Economic Development - Alaska
Legal
State Form 44614 - Application For A License To Practice Veterinary Medicine Or Registration To Practice Veterinary Technology
Financial
Related Categories
Parent category: Business