Application For Kansas Veterinary License printable pdf download

INSTRUCTIONS FOR LICENSE APPLICATION ---READ CAREFULLY

1. Fill out exactly as you wish your name to appear on your license. Maiden name is for our records only.

2. Be sure to use a complete and current address for the time of the application process. If more that one address

will be used in the next 60 days, include the second address on an enclosure with an explanation.

3. KSA 74-139 says that upon request of the Director of Taxation, the board is required to provide the name, social

security number, and address of the license holders in the state. The social security numbers are used by this agency

for identification and the Professional Examination Service asks for the social security numbers for their

identification. You may legally decline to disclose this number.

4. Be able to verify verbally if asked by the board. Federal law prohibits state licensing agencies from licensing

certain aliens. 8 U.S.C. § 1621.

5. Personal data for identification purposes

6. The complete date please. Enclose photocopy of diploma. Please provide a copy of diploma if already graduated

or; if enrolled in AVMA accredited college, a letter from Dean's office verifying enrollment or; if enrolled in non-

accredited college, a letter from ECFVG verifying enrollment and completion of steps 1, 2, & 3.

7. List all licenses, whether active or inactive.

8., 9.,10. The board requires complete information on all areas of the application. Attach extra sheets as needed.

If asked by board, this information must be verifiable.

11. This photo should have your face size a minimum of 1 inch and the overall photo size should not exceed 3 x 4

inches. Poor quality photos, snapshots, group pictures, caps or hats obscuring parts of the face, and colored

glasses will cause photos to be rejected.

12. Read the affidavit. It is your oath carrying with it the penalty of law, and must be witnessed.

13. It is your duty to contact the other states in which you are, or ever have been, licensed and have them send their

verification directly to our board.

14. Explain any YES answers in detail.

15. Unless reported to Kansas, the scores from the NAVLE, or NBE (National Board Examination) and the CCT

(Clinical Competency Test), must be forwarded to the board by VIVA (Veterinary Information Verification

Agency), a service provided by AAVSB (American Association of Veterinary State Boards). Applicants

E-mail

; AAVSB website:

graduated prior to 1980 are exempt from CCT.

16. When the Applicant State of Confidentiality is signed and returned, to our office, with a completed

application and appropriate fees, you will be sent an open book Kansas jurisprudence examination. You

must correctly answer 90% of the questions on this open book exam. If you do not correctly answer 90% of

the questions, you must retake the examination. Please print the following forms, complete as directed,

and submit with your application.

Applicant Statement of Confidentiality and Certificate of Moral Character

17. Attach application fee of $125.00. No cash accepted. Make your check payable to: Kansas Board of Veterinary

Examiners

APPLICATION FEE OF $125.00 IS NOT REFUNDABLE.

KANSAS BOARD OF VETERINARY EXAMINERS

PO Box 379

Wamego, Kansas 66547

PHONE: 785-456.8781

Application For Kansas Veterinary License