VM 22500 Clinical Mentorship Documents

Beginning for the spring 2020 semester, all clinical mentorship documents will be completed using DocuSign.  Below are links and directions for completing all four mentorship documents.  The last link is for the VM 22500 clinical mentorship logbook.

VM 22500 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 site veterinarian, 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 22500 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 – 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 – 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.

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

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 lasts for up to a year and runs from Aug. 1 through July 31.  You only need to complete this form once a year.  This $13 fee is billed through the Bursar’s Office 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 secretary.

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

VM 22500 Clinical Mentorship logbook