North American Veterinary Licensing Examination Eligibility Form     (NAVLE)


West Virginia Board of Veterinary Medicine
 5509 Big Tyler Road, Suite 3
Cross Lanes, WV 25313
Phone (304)776-8032                                            Fax (304) 776-8256                        Email: wgoodwin@wvnet.edu

Attach actual photograph approximately 2 x 2 here. (no scanned copies please) Place signature on back of photograph .The NAVLE booklet has an application form enclosed for the NAVLE examination. You may also access the NAVLE application at www.nbvme.org 
It is to be completed and submitted directly to the NBVME with the NAVLE testing fee of $480.00.

Candidate's Full Name: ___________________________________________________________________
Permanent Mailing Address: ____________________________________________________________________________________
 Street                                                                               City                  State                    Zip Code

Phone Number: __________________ FAX # _____________Email Address: ________________________
                             Be sure to enter area code
 Date of Birth: __________________________ Place of Birth: _____________________________________

Social Security Number: _________________________________

Candidate is a senior student or graduate of ___________________________ School or College of Veterinary Medicine.

Date of or scheduled date of graduation: _____________ Is this school accredited by the AVMA? _________

 If a student; candidate must be within six (6) months of the expected graduation date for the testing window requested. Student candidates must supply a letter from the office of the Dean of the veterinary school verifying student's expected graduation date, with original signature.

Graduate veterinarians must submit a copy of diploma that has been notarized with a statement that the notary public has seen the original document and verifies duplicate to be an exact copy of the original. Graduate veterinarians may also send an official transcript showing graduation date or a letter from the Dean, with original signature, as verification.

If enrolled in, or a graduate of a foreign veterinary school, candidate must supply official verification of completion or current enrollment in the Educational Commission for Foreign Veterinary Graduates (ECFVG) program or the Program for the Assessment of Veterinary Education Equivalence (PAVE) program at the time of this application.

NAVLE testing window requested: Nov. 17-Dec. 13, 2008   ____                April 13-25, 2009 ____

I do hereby certify by my signature below, that all information on this eligibility form is true and correct.

Candidate's Signature: _____________________________________________ Date: _______________