Certification Application

wyvta.org

Mission:

The Wyoming Veterinary Technician Association is dedicated to advancing veterinary technology by providing quality continuing education, increasing awareness of the significance of our profession, and elevating the standards of the entire veterinary support team.

Wyoming Veterinary Technician Association

WELCOME

Statewide support for ALL veterinary staff including:

• Continuing education at least once per year
• Opportunities to get involved with the community to teach them about the veterinary health care team (i.e. ideas and support for local functions)
• Social events
• Team efforts for supporting the veterinary health care team and a chance to get involved at the state and national levels to promote veterinary technology
• Experienced individuals with leadership, camaraderie, and a sounding board to discuss issues, articles, jobs, futures, and etc.

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 Type	Phone Number

Phone
Phone Type	Phone 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 Type	Phone 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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