Attestation Of Veterinarian'S Provision Of Free Spaying And/or Neutering Services For Continuing Education Credit printable pdf download

Veterinarian

The University of the State of New York

THE STATE EDUCATION DEPARTMENT

COSN Form

Office of the Professions

State Board for Veterinary Medicine

Attestation of Veterinarian's Provision of Free Spaying

and/or Neutering Services for Continuing Education Credit

Instructions

This form must be filled out and signed by veterinarians who choose to provide free spaying and/or neutering services for continuing

education credit. Once completed, it is recommended that you keep this form at the your practice location. You are required to provide it,

along with any attached documentation, to the New York State Education Department upon request. If you are not claiming free spaying

and/or neutering services for continuing education credit, you do not need to fill out this form.

Free spaying and/or neutering services can only be used to satisfy a portion of your continuing education requirement, if such services

were, among other things, provided in conjunction with a municipality, duly incorporated not-for-profit society for the prevention of cruelty

to animals, duly incorporated humane society, or duly incorporated animal protection association or persons who would otherwise be

eligible under Agriculture and Markets Law Section 117-a(3)(a).

If you provided free spaying and/or neutering services to a dog or cat owner, who is eligible to participate in the animal population control

program under Agriculture and Markets Law Section 117-a(3)(a), attach a copy of the pet owner's adoption agreement with the pound,

shelter maintained by or under contract or agreement with the state or any county, city, town, or village, duly incorporated society for the

prevention of cruelty to animals, duly incorporated humane society, or duly incorporated dog or cat protective association that the dog or

cat was adopted from.

You may claim a maximum of 3 hours of continuing education credit by providing free spaying and/or neutering serves per registration

period. Each hour of free spaying and/or neutering service provided equals one half hour of continuing education credit.

In order for the provision of free spaying/neutering services to satisfy a portion of your continuing education requirements, such services

must have been administered at practices, facilities and properties that were appropriately equipped and staffed to provide such services.

Additionally, you must have provided any needed follow-up services, which are referred to as other veterinary services for continuing

education credit purposes, for any post-operative complications related to any such surgeries that arose within 24 hours of performing

them. You must also complete the core continuing education requirements for veterinarians.

Print Name:

Last

First

Middle

Mailing Address:

(You must notify the Department promptly of any address or name changes.)

Line 1

Line 2

Line 3

City

State

ZIP Code

Country/

Province

New York State Veterinarian License Number:

Registration Period: _____________________________________________________

Veterinarian - COSN Form, Page 1 of 2, February 2017

Attestation Of Veterinarian'S Provision Of Free Spaying And/or Neutering Services For Continuing Education Credit

Related Articles

Related forms

Related Categories