4669 Southwest Freeway # 100
Houston, TX 77027
713.629.1500
We at Vet Tech Institute would like to thank you for your participation in the Veterinary
Technician Program. The externship is the culmination of an eighteen-month program of study,
and provides valuable on-the-job experience in a veterinary facility with animal care professionals.
The students have performed all of the practical procedures included on the evaluation form on
live patients at the school. The externship should give them the opportunity to build upon these
elementary-level skills.
The student is required to complete this externship of approximately 288 hours over a period of
eight weeks as outlined on the evaluation form. He/she should work out a mutually convenient
schedule with your facility.
Please find enclosed:
1. Affiliation agreement for you to read, sign, and return to the school*
2. Evaluation form to be completed on the last day of externship and returned to the school*
3. Expectations List
4. A copy of the student’s skills list showing what skills the student should or could perform
during his/her externship.
Forms can be returned with the student, faxed (713.629.8945) or emailed back @
VTIexternship@vettechinstitute.edu
We hope that your participation will prove beneficial to both you and the student. If you have any
questions or concerns, please contact Catherine Huff, RVT, Program Director, at 713.985.5125 or
Danene Birtell, RVT, Placement Director at 713.985.5113
Sincerely,
Catherine Huff, RVT
Danene Birtell, RVT
Catherine Huff, RVT
Program Director
Danene Birtell, RVT
Placement Director
Externship/Clinical Affiliation Agreement
The Agreement is entered on this day ______________________ by and between
Vet Tech Institute, (“VTI”) and ____________________________ (the “Externship Site”).
Facility Contact Information:
Address: ________________________________________________________________
Phone Number: __________________________________________________________
Email: __________________________________________________________________
Printed Name of Primary Contact: ____________________________________________
This Agreement shall continue in effect until modified or terminated as hereinafter provided.
VTI works in cooperation with veterinary care facilities in the Greater Houston Area as
well as other areas of the United States to train students to qualify as competent, entry-level
Veterinary Technicians. This joint effort with medical community resources has proven to be a
successful and productive educational technique. The objective is that the relationships developed
between VTI, its students and Externship Site benefits all parties.
To meet this goal, VTI works with veterinary care facilities to provide students with actual
experience gained through participation in externship.
VTI has primary responsibility for the academic growth and progress of the student. The
Externship Site provides the setting for students to grow in knowledge and skills through
experience gained through association with the facility and its professional staff.
VTI and Externship Site do hereby agree to the following:
1.
2.
3.
4.
VTI and Externship Site will work together closely to educate
students and thereby graduate competent health practitioners.
VTI shall advise the Externship Site of the start date and the
number of hours needed to complete externship. (288 hours)
Students and Faculty of VTI will abide by the rules and regulations
of the Externship Site insofar as they may pertain to their activities while
serving externship. The Externship Site agrees to provide the necessary
orientation, administrative guides and procedures, and other supervision
deemed essential to the conduct of the work experience.
Students are expected to maintain satisfactory professional behavior
acceptable to the Externship Site and School. Any disciplinary problems
will be worked out between VTI’s Veterinary Technician Program
5.
6.
7.
8.
9.
10.
11.
12.
13.
Manager and the Externship Site’s Supervisor.
The Externship Site will designate an employee to serve as Educational
Supervisor of students placed in the Facility.
The Externship Site will maintain administrative and professional
supervision of students insofar as their presence affects the operation of
the facility and/or the direct or indirect care of patients.
The externship facility will provide laboratory and radiology protective gear
including dosimetry badges.
The student will be responsible for her/his personal expenses while on
externship.
The student will not be expected to provide service to the Externship Site
apart from that rendered for its educational value.
Members from both VTI and the Externship Site will participate in
the evaluation of student performance in accordance to the course objectives listed
below. The evaluation form included with this affiliation agreement will be
completed by the Externship Site and sent to VTI promptly upon completion of the
externship.
VTI and the Externship Site will not discriminate against any
student because of color, race, creed, sex, handicap, or national origin.
This Agreement may be modified in writing upon agreement of both
parties at any time. Either party upon thirty days written notice to the
other may terminate it.
The student is permitted to receive payment from the externship site. This
is neither expected nor mandatory.
IN WITNESS WHEREOF the parties hereto have executed this Agreement as of the date
first above written.
For the Externship Site:
________________________________
Physician/Director
________________________________
Office Manager
________________________________
Student Name
For Vet Tech Institute:
Catherine Huff, RVT________
Veterinary Technician Program Director
Danene Birtell, RVT
Veterinary Technician Placement Director
VETERINARY TECHNICIAN
COMPETENCY REPORT OF EXTERNSHIP PERFORMANCE
STUDENT’S NAME: ____________________
FACILITY: ____________________________________
ADDRESS: __________________________________________________
FACILITY’S TELEPHONE NUMBER: ____________________
SUPERVISOR: _______________________
EXTERNSHIP DATES:
FROM: ____________ TO: _______________
Please do not hesitate to critically evaluate the student’s performance in your facility using the
evaluation code below. If the student has not performed a particular procedure, please note NA
(not applicable).
1.
Unable to perform procedure
Using the evaluation code
2.
Limited skill – requires supervision
provided, what, in your
opinion
Moderate skill – requires minimum supervision
3.
would be the student’s
overall
Expanded skill – works independently and at a high level
4.
percentage:
_________________
N/A
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
situation
NA
NA
NA
NA
NA
Not applicable
GENERAL ATTITUDE AND ABILITY
Able to communicate well with employer, clients, and other staff members
Able to grasp new skills and follow through with procedures
Displays initiative and willingness to work
Appearance satisfies your professional standards
Able to observe situations and applies common sense principles to handle the
GENERAL OFFICE AND HOSPITAL PROCEDURES
Able to perform basic housekeeping and sanitary duties without being told
Able to handle patient admittance and discharge
Able to maintain appointment control
Able to obtain and file patient’s record
Able to take inventory and order supplies
Able to receive and place telephone calls
Able to understand pharmacy records
Able to exhibit a general knowledge and observation of patient’s name, appetite,
bowel and bladder habits, and other general condition
1 2 3 4 NA Able to record clinical history
1 2 3 4 NA Able to exhibit a professional attitude with clients and staff
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
NA
NA
NA
NA
NA
NA
NA
NA
CLINICAL PROCEDURES
Able to perform restraint of animal without injury to animal, veterinarian, or assistant for general
procedures:
1 2 3 4 NA Dog
1 2 3 4 NA Cat
1 2 3 4 NA Laboratory animals
1 2 3 4 NA Able to perform and understand caring, feeding, and kennel maintenance principles
for animals
1 2 3 4 NA Able to perform routine radiography procedures
1 2 3 4 NA Able to read technique chart, make proper settings, and use proper positioning for
radiographs
1 2 3 4 NA Able to develop radiographs
1 2 3 4 NA Respects need for x-ray safety
1 2 3 4 NA Able to assist in application of bandages, casts, and splints
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
4
4
NA
NA
NA
NA
NA
NA
MEDICAL NURSING PROCEDURES
Able to recognize normal and abnormal conditions
Able to perform TPR of small animals
Able to administer SC, IM, and IV injections
Able to administer treatments prescribed by the veterinarian
Able to handle dental prophylaxis
Able to operate ECG machine
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
NA
NA
NA
NA
NA
NA
NA
SURGICAL NURSING PROCEDURES
Understands need for asepsis in surgery
Able to assist in pre – and post-operative care of animals
Able to prepare surgery packs and properly sterilize instruments and equipment
Able to assist with anesthetic induction and intubation
Able to monitor anesthetized animal
Able to recognize an emergency situation
Able to clean and maintain surgery room
1
1
1
1
1
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
NA
NA
NA
NA
NA
VETERINARY LABORATORY PROCEDURES
Able to perform a CBC
Able to perform a complete urinalysis
Able to perform parasite tests (intestinal worms, ear mites, and mange mites)
Able to perform heartworm tests
Able to collect and prepare samples
COMMENTS:
__________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
__________________________________________________________
VETERINARY TECHNICIAN
COMPETENCY REPORT OF EXTERNSHIP PERFORMANCE
STUDENT’S NAME: ____________________
FACILITY: ____________________________________
ADDRESS: __________________________________________________
FACILITY’S TELEPHONE NUMBER: ____________________
SUPERVISOR: _______________________
EXTERNSHIP DATES:
FROM: ____________ TO: _______________
Has the student been scheduled for 288 hours of Externship?
YES
NO
Has the student been hired?
YES
NO
If yes, salary __________
Over all grade: ________________
Supervisor’s Signature
Position
Veterinary Technician Program
Manager’s Signature
Date
Externship Site / Student Expectation Protocol
Student Expectations:







Student should call the site one week prior to start for:
o Schedule hours
o Dress code
Student should be prompt every day.
o In the event that a student is absent;
 They should call both the site and the school.
Student should conform to the practices of his/her site as long as it applies within the
OSHA guidelines.
Students are absolutely forbidden to:
o Diagnose illness
o Prognose outcomes
o Prescribe medication
o Perform any surgical procedures
Students are expected to behave in a professional manner AT ALL TIMES!
If the need arises for counsel with the student, conversation between individuals should be
dated and documented.
Communicate with the Program Director and Placement Director, as needed.
Site Expectations:






An affiliation agreement between your site and the school should be signed and faxed or
emailed back
The site should provide:
o Orientation
o Administrative guidelines
o Administrative procedures
o Professional supervision of both direct and indirect care of the patient
o An employee to serve as an educational supervisor to the student.
Provide students with actual experience gained through participation.
o Student should serve 288 hours
Provide a setting for students to grow in knowledge and skills.
o An AVMA skills guideline will be given to you for guidance on skills
Participate in a written evaluation of the student’s performance and prompt return of
paperwork.
o This is once the student has completed the externship
Communicate with the Program Director and Placement Director as needed.
o Catherine Huff , RVT
713.985.5125
o Danene Birtell
713.985.5113