Clinical Site and Adjunct Interest Form

If you would like to learn more about potentially participating in the Lincoln Memorial University College of Veterinary Medicine Clinical Year Community Based Distributed Veterinary Education Program, please complete the following and submit. Selected LMU-CVM Community Based Distributed Educational Partners deliver teaching opportunities to clinical year students in four (4) week clinical rotations. Shortly after submission of this information, someone from LMU-CVM will contact you.

Questions? Please contact . . .

In order to host LMU-CVM students, a veterinarian or PhD, directly involved in animal topics/research is required to supervise and oversee LMU-CVM students at the facility.

Name (required)
If not a Veterinarian, please list credentials:
Name of Facility (required)
Facility Address (required)
City (required)
State (required)
Zip (required)
Veterinarian Phone (required)
Facility Phone
Veterinarian Email (required)
Facility Email
Website address of Facility (if any)
Other Veterinarians at Facility (if any) that may be interested in participating in the Educational Program (one per line)
Specialty Designations – please list veterinarian name and any specialty designation/ diplomate status, if any: (one per line)
Special Interests or characteristics of veterinarians or facility
Area(s) in which veterinarians and facility are interested in training LMU-CVM students (e.g. Small Animal General Practice, Small Animal Emergency & Critical Care, Specialty Medicine-Ophthalmology, Mixed Animal Practice, Small Animal Internal Medicine, Small Animal Surgery, etc.)
Potential Lecture topics that could be delivered (please list name of veterinarian with topic, if more than one veterinarian noted above).
Potential number of students that veterinarians and facility could engage and teach in a 4 week clinical rotation on an annual basis (Please note, for each 4 week clinical rotation, 2 students are preferred)
LMU-CVM seeks to engage interested members of the veterinary community to be partners in the educational process of LMU-CVM students. Please note if you would have any interest in participating in the following:

Facilitate on-campus LMU-CVM clinical skills lab?

Interested in Part-time or Full-time LMU-CVM faculty position?

Host LMU Veterinary Technology students at facility?

Do you currently employ a:

LMU-CVM graduate veterinarian?

LMU Veterinary Technology graduate?

Would you be interested in learning more about the LMU Veterinary Technology graduates and the LMU Veterinary Technology program? – If Yes, someone from the LMU Veterinary Technology program will follow up with you in the near future.
Other comments or questions