Student participation form

This registration form is to enable us to match students with veterinarians to create mentoring partnerships. We will try to match you with a veterinarian in your field of medicine interest and in an area of the state or area of the country you chose, as best we can.

* 1. What is your first name?

* 2. What is your last name?

* 3. What is your email address?

* 4. What is your year of graduation?

* 5. What are your areas of interest? (rate top choices from 1-3)

* 6. If you chose board certification or specialty medicine, please list specific interest below. (surgery, internal medicine, cardiology, rehabilitation, alternative medicine, etc.)

ISVMA regions map

ISVMA regions map

* 7. If you would like your first choice for your veterinarian partner to be located in Illinois, please choose that area below. If you would like your veterinarian partner to be located outside of Illinois, please skip this question.

* 8. If you are more interested in area outside of Illinois, please choose the location below. (Please select an answer for this question, or one in the previous question.)

* 9. We recommend that you not request a veterinarian partner whom you already know well. If you still have a specific request for a veterinarian partner, list the name and where they work below.