Wyoming Veterinary Technician Association

PO Box 34
Cody, WY 82414

(307)899-3189

www.wyvta.org

CLICK HERE TO DOWNLOAD THE CERTIFICATION APPLICATION

OR SUBMIT THE ONLINE FORM BELOW

Certification Application Form

Name
First Name
Last Name
Address (MAILING)
Street Address
City
,
State / Province
Zip / Postal Code
Address (PHYSICAL)
Street Address
City
,
State / Province
Zip / Postal Code
E-Mail Address :
Phone
Phone TypePhone Number
Phone
Phone TypePhone Number
Work Address
Street Address
City
,
State / Province
Zip / Postal Code
AVMA accredited Veterinary Technology (Animal Health Technology) Program attended

Address
Street Address
City
,
State / Province
Zip / Postal Code
Graduation Date :
Phone number of program
Phone TypePhone Number
The following items ARE REQUIRED, please check appropriate boxes:
1. Certificate Application Type: Check the appropriate box. (one selection only; $10 fee must accompany membership dues/application and certification application).
New, first time WyVTA CVT Application = $ 10.00
Lapsed, overdue WyVTA, CVT Renewal (if received after Dec. 31, 2019) = $ 10.00
2. Copy of Veterinary Technician Program graduation/diploma attached (new applicants only)
New applicant
Returning, my diploma is on file with the WyVTA
3. Select one
VTNE scores are being transferred
VTNE scores are already on file with the WyVTA
4. Continuing Education certificates from previous 2 years *10 hours of approved CE is required every 2 years (RACE, WyVTA, WyVMA, NAVTA, or AVMA approved)
Continuing Education certificates from previous 2 years attached
New graduate (under 2 ​years since graduation date, Continuing Education certificates waived)
5. Proof of license/registration/certification if transferring from another state:
Attached
N/A
6. Biennial Membership dues of $40 and the Membership Application are required to be submitted IN ADDITION to this complete CVT application packet. Note Certification Fees due only if new certification or ​certification is lapsed​/overdue.
Make checks payable to the WyVTA
Please send completed applications and fees to: Jackie Van Noy, CVT; WyVTA Membership & Certification 1532 26th St, Cody, Wy 82414

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