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AVA CVP Accreditation Pathway Admission Form

Application

First name*

Middle name(s)

Family name*

Preferred name

Email*

Alternate email address

Phone (Mobile)*

Phone (work)

Phone (home)

Address Line 1

Address line 2

Suburb

State -- Select an option -- NSW QLD VIC WA ACT SA NT TAS

Postcode*

When do you wish to commence your studies in the AVA Chartered Veterinary Practitioner™ accreditation pathway? -- Select an option -- January 2024 July 2024 January 2025

Are you a financial member of the AVA? -- Select an option -- Yes No

AVA membership number

Are you a financial member of the Australian Small Animal Veterinarians (ASAV) special interest group? -- Select an option -- Yes No

How many years have you been practicing as a small animal practitioner?

Have you completed veterinary science training? -- Select an option -- Yes No

Please include evidence of your veterinary science qualification

Are you currently registered to practice veterinary science in Australia? -- Select an option -- Yes No Completing AVBC exams

Which state/territory are you currently registered as a veterinary surgeon? (choose all that apply) -- Select options -- NSW QLD VIC SA WA ACT NT TAS

What is your Primary Vet Board Registration Number?

Will you have ongoing access to small animal practice for the duration of your studies? -- Select an option -- Yes – Current practice Yes – Locum No

Please include the name of the veterinary clinic in which you will have ongoing small animal practice access. If you will be undertaking locum work, please include the name of your current practice.

Individual course fees are payable as you enrol in each course. Please nominate your preferred payment method. -- Select an option -- Invoice – Issued to me Invoice – Issued to my employer

I approve for the AVA to update any of the information outlined below in my records with them.

Yes

No

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