MAV Scholarship Applications Oct 2019 CuraCore MAV Scholarship for College Faculty Oct 2019 Application Step 1 of 4 25% Medical Acupuncture for Veterinarians Program - Fort Collins, Colorado. Course size is limited to ensure high-quality instruction for all participants. Scholarship applications are accepted from qualified applicants. 2019 Fall Clinical Intensive Dates October 14 - 19, 2019 Basic InformationName* First Last Title DVM VMD Other If 'Other,' please provide your title herePractice Focus (check all that apply) Large Animal Small Animal Equine Exotic Other If 'Other,' please specify your practice focusVeterinary College Graduated From*Year of Graduation*State Where Licensed*License Number (upload a copy of your license below)*Upload a copy of your current veterinary license or letter from your school showing that you are a student in good standing or a faculty member that does not require a veterinary license to teach and practice. You will be enrolled in the course once this has been received, reviewed, and accepted.Accepted file types: pdf, jpg, png, .Formats accepted are pdf, jpg, png. The file will upload when you submit the form.Indicate the accredited veterinary teaching university you are employed by*How long have you been teaching at this university*Is your faculty appointment: (check one)* Full time Part time Type: (check one) 100% Research 100% Teaching Combined Teaching & Research Please provide your Curriculum Vitae*Please tell us why you would like to enroll in our Medical Acupuncture for Veterinarians program*What are your goals for adding medical acupuncture to your clinical practice*Please list all previous courses you have taken in integrative medicine (e.g acupuncture, chiropractic, herbal medicine, laser therapy, etc.)*How did you hear about this scholarship (check all that apply)* Website Friend/Co-worker School Conference Other Please indicate the school, conference or where you learned about this scholarship: Contact InformationMailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Is this address your home or work address? Home Work Work PhoneCell PhoneEmail Address* Program SelectionVeterinarians - October 2019 Tracks - Please choose course*October 2019 Dual Track: 12 Modules of MAV (Small Animal/Exotics AND Equine/Farm Animals)October 2019 Small Animal/Exotics TrackOctober 2019 Equine/Farm Animals TrackSign Up for Our Course Announcements Sign me up! Questions? Contact Sharon Sherwood at email@example.com or 970-818-0851.PhoneThis field is for validation purposes and should be left unchanged.