Form Il486-1019 - Application For Licensure And/or Examination
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22INSTRUCTION SHEET
Veterinarian
Examination
Acceptance of Examination
Endorsement of Licensure
Restoration
In order for your application to be processed,
ALL REQUIRED SUPPORTING DOCUMENTATION MUST BE SUBMITTED
with the application and required fee unless otherwise directed in the instructions.
To apply under the provisions of the Illinois Veterinary Medicine and Surgery Practice Act of 1994, read and follow each
of the steps below in the order they are listed. This will aid you in accurately completing your application and thus, elim-
inate any delay in processing. The application which you submit is valid for 3 years from date of receipt. If you are
issued a license, please be advised your license will expire on January 31 of each odd-numbered year.
Step I -- Application
Complete the four-page Application for Licensure/Examination as follows:
1. Part I-A: Application Category Information--Select method of applica-
tion and complete Part I as indicated below:
2. Profession Code
4. Fee
1. Profession Name
3. Licensure Method
Veterinarian
090
Examination
*
Veterinarian
090
Acceptance of Examination
*
Veterinarian
090
Endorsement of Licensure
*
The Illinois Controlled Substances Act
Veterinarian
090
Restoration
**
requires that every person who manu-
factures, distributes or dispenses any
*See attached Reference Sheet for fee amount.
controlled substances within this State
**See Supporting Document RS for fee amount.
must obtain a controlled substance
license issued by the Department of
2. Part I-B: Check the box indicating the appropriate information regard-
Financial and Professional Regulation.
ing your application.
3. Part II: Applicant Identifying Information--Enter all applicable informa-
An application for controlled substance
licensure is enclosed for this purpose.
tion requested.
4. Part III: Education Information
a. Numbers 1 through 5--Enter all applicable information requested.
b. Number 6--Indicate both Preveterinarian AND Veterinarian educa-
tion.
5. Part IV: Record of Licensure Information--Indicate in this area if you have
ever held a license as a Veterinarian or other related license. Supporting
document CT must also be completed by all jurisdiction of the United
States in which you have ever been licensed.
6. Part V: Record of Examination--Must be completed by all applicants.
Additional application forms can be downloaded from the IDFPR Web site at
DPR-I-VT -- Instructions Revised 5/14
Packet Updated 10/25/16
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