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VM 20500 Clinical Mentorship Documents

The clinical mentorship documents below are completed using DocuSign. Below are links and directions for completing each document.

When you complete the student section of this Facility Requirement Agreement, you will be asked if you have “received the complete pre-exposure rabies vaccination series.” For you to select “yes” you must have completed the following rabies vaccine requirements as outlined on the CDC website: Initial rabies vaccine series (2-dose series given at days 0 and 7) plus either (a) a 1-dose booster between 3 weeks and 3 years following the initial 2-dose vaccine series or (b) a one-time titer check after 1 year and up to 3 years following the initial 2-dose vaccine series.

Clinical Mentorship and Facility Requirement Agreement

Clinical Mentorship and Facility Requirement Agreement - When you click on this link, a page will open that will require you (the student) to enter your name and Purdue email address. You will also need to enter the name of the practice owner or designee and their email address. DocuSign will guide you through the document until you have completed the student portion of the document. Once completed, it will be sent automatically to the email address you provide for the practice owner or designee so they can complete their part of the form. Once they complete their part of the form, it is automatically sent to the VNDL secretary.

This agreement is between you, the Clinical Mentorship facility, and Purdue University. It states that the Clinical Mentorship site will provide you with the experience you need, that you will take certain responsibilities for your behavior and wellbeing, and that Purdue certifies that you are a VNDL student. Please read this carefully so you understand your responsibilities!

Each Clinical Mentorship has specific requirements for equipment and disposable supplies to which you must have access. If a veterinary practice does not have such equipment or supplies, or if these supplies or equipment are not accessible to you, you will have to select another site for your Clinical Mentorship for that particular mentorship experience. Each item box much be checked. It is the student’s responsibility to make sure that the practice owner or designee completes their portion of the DocuSign form in a timely manner. If you or your designee have any questions in regards to completion of clinical mentorship forms or required equipment, please contact the VNDL office.

Each Clinical Mentorship must adhere to animal use guidelines that are described in detail in the VM 20500 clinical mentorship logbook. It is essential to our program's accreditation that your experience observe these guidelines. You and your mentor must acknowledge animal care and use guidelines and agree to adhere to them.

Clinical Mentorship Supervisor Agreement

Clinical Mentorship Supervisor Agreement - When you click on this link, a page will open that will require you (the student) to enter your name and Purdue email address. You will also need to enter the name of the credentialed veterinary technician or licensed DVM who will be your clinical mentorship supervisor along with their email address. DocuSign will guide you through the document until you have completed the student portion of the document. Once completed, it will be sent automatically to the email address you provide for your clinical mentorship supervisor so they can complete their part of the form. Once they complete their part of the form, it is automatically sent to the VNDL secretary.

If you are taking multiple mentorships in a semester, you must complete one (1) Clinical Mentorship Supervisor Agreement for each mentorship. A separate Supervisor Agreement must be completed for each supervisor who will sign your Task Verification forms, if you have multiple supervisors. It is the student’s responsibility to make sure that their mentorship supervisor(s) completes their portion of the DocuSign form in a timely manner.

Student Acknowledgment Form

Student Acknowledgment Form - When you click on this link, a page will open that will require you (the student) to enter your name and Purdue email address. This form has several links to information that you will need to read, then check the appropriate checkboxes and sign/date at the bottom. When completing this form, you must select the appropriate checkboxes to indicate that you have read and agree to the information contained in the provided weblinks. Once you complete this form, it is automatically sent to the VNDL secretary.

IMPORTANT** If you are taking multiple mentorships in a semester, you only need to complete one (1) Student Acknowledgment Form.

Professional Liability Insurance Coverage

Professional Liability Insurance Coverage - When you click on this link, a page will open that will require you (the student) to enter your name and Purdue email address. Professional liability coverage for clinical mentorships runs from August 1 through July 31 each year. Regardless of what semester you register initially, it must be renewed each August.  This form only needs to be completed once during the year/partial year of coverage.  The $13 fee is billed through the Bursar, allowing it to be paid in the same manner that tuition is paid. Once you complete this form, it is automatically sent to the VNDL Administrative Assistants to verify your coverage.

IMPORTANT** If you are taking multiple mentorships in a semester, you only need to complete one (1) Professional Liability Insurance Coverage form.

Logbook

VM205 Clinical Mentorship Logbook