Wyoming Veterinary Technician Association

PO Box 34
Cody, WY 82414

(307)899-3189

www.wyvta.org

Certification Fee $10.00

PAY NOW

CLICK HERE TO DOWNLOAD THE CERTIFICATION APPLICATION for 2021-2022

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
Work (Name)

Work (Address)

AVMA accredited Veterinary Technology (Animal Health Technology) Program attended

AVMA accredited program address

Graduation Date :
Phone number of program

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 Jan. 10, 2021 = $ 10.00
Certification application renewal received by January 10, 2021 = NO CERTIFICATION RENEWAL FEE.
2. Copy of Veterinary Technician Program graduation/diploma attached (new applicants only)
New applicant, sending to WyVTA
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 are being emailed to CVT_Members@wyvta.org
Continuing Education certificates from previous 2 years are being mailed to: WyVTA Membership & Certification 1532 26th St Cody, WY 82414
5. Proof of license/registration/certification if transferring from another state:
Emailing to CVT_Members@wyvta.org
Are being mailed to: WyVTA Membership & Certification 1532 26th St Cody, WY 82414
N/A
6.
If you have downloaded the application, complete it and send it to the WyVTA mailing address along with your copies of required CE receipts, and your check payment.
If you would like to pay via credit card click the appropriate credit card payment link.to pay with our secure Square account.
REMINDER: 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
Send completed applications and dues to: Jackie Van Noy, CVT; WyVTA Membership & Certification 1532 26th St Cody, WY 82414
Enter the last 4 digits of the credit card you'll be using. Or if sending a check, type in CK

-- ASSOCIATION USE ONLY-- (nothing for you to fill out)
Date Received: . Check #: . Amount: . Membership card sent: . CE received: . Are things correct?: . Follow up: _______ / ________ / _________

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