Applicant Information:

Name: *

Permanent Street Address: *

Permanent City, State and Zip Code Address: *

Phone Number: *

Alternate Phone Number:

Email Address: *

Date of Birth: *

Veterinary School: *

Graduation Date: *

Place of employment at time of application: *

Veterinarian Educational Loan Balance(s):

Total of all Federal Student Loan(s) Balance:

Total of all Private Student Loan(s) Balance:

Veterinarian Qualification:

Each box must be checked indicating the applicantion meets the minimum qualifications for the program.

I have been awarded a Doctor of Veterinary Medicine degree from an eligible veterinary college after January 1, 2023.

I have a current veterinary license in Arizona

My veterinary college educational loans are not delinquent or in default

I understand I must enter into an agreement with the Arizona Board of Regents indicating that you will work as a full-time veterinarian in Arizona for the following four years after obtaining a valid licensure in Arizona.

I understand I must work full-time in one of the following practice areas for at least two of the four years:

• Agricultural practice in an area designated by the United States Department of Agriculture as having a shortage.

• A nonprofit, county or municipal shelter

I understand I am responsible for any federal and state taxes associated with accepting these funds.

Required Documents

Transcript(s) showing a Doctor of Veterinary Medicine degree or its equivalent *

A copy of your Arizona Veterinary License *

Federal and Private Promissory Notes *

Documentation of all federal loans found in your Federal Student Aid (FSA) account showing their balance

Documentation of all private student loans showing their balance

I understand that this is an application for the Veterinary Loan Assistance Program (AVLAP) and no funds are guaranteed at this time. I understand that if funds are awarded to me I will be required to sign an agreement with the Arizona Board of Regents outlining the requirements to receive the funds. *

clear