S/N Clinic Mentorship Follow-up Training Application
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NSNRT Clinic Name *
Clinic City *
Clinic State *
Clinic Zip Code *
Your Name *
Your Title *
Contact Phone *
Contact Email *
General Timing
What are your preferred training dates? *
While we cannot guarantee a specific date, if you can provide some dates/months that work better for you, we will do our best to accommodate. Please keep in mind that trainings in Asheville are Monday-Thursday.
Full Attendance *
Will all of your team attend in one sitting? If you need your team to come in shifts, please complete this request form for each shift.
Your Medical Team
Your veterinarian will need to obtain a North Carolina temporary license. Details will be sent once dates have been confirmed.

In ASPCA Spay/Neuter Alliance terms, a veterinary technician (licensed or not) is the person who handles the controlled substances, does intubations, and injections. A veterinary assistant is primarily responsible for patient prepping and patient care.
Staff #1 First Name *
Staff #1 Last Name *
Staff #1 Email *
Email address of program participant (to reach in case of emergency)
Staff #1 Phone *
Cell phone of program participant (to reach in case of emergency)
Staff #1 Position *
Time in Position *
How long has this person been in this position, i.e., three months
Primary Duties *
Please list primary duties/responsibilities for this person
Repeat Training *
Has this staff member previously attended training at ASPCA Spay/Neuter Alliance?
Staff #2 First Name
Staff #2 Last Name
Staff #2 Email
Please use a personal email address
Staff #2 Position
Clear selection
Time in Position
How long has this person been in this position, i.e., three months
Primary Duties
Please list primary duties/responsibilities for this person
Repeat Training
Has this staff member previously attended training at ASPCA Spay/Neuter Alliance?
Clear selection
Staff #3 First Name
Staff #3 Last Name
Staff #3 Email
Please use a personal email address
Staff #3 Position
Clear selection
Time in Position
How long has this person been in this position, i.e., three months
Primary Duties
Please list primary duties/responsibilities for this person
Repeat Training
Has this staff member previously attended training at ASPCA Spay/Neuter Alliance?
Clear selection
Staff #4 First Name
Staff #4 Last Name
Staff #4 Email
Please use a personal email address
Staff #4 Position
Clear selection
Time in Position
How long has this person been in this position, i.e., three months
Primary Duties
Please list primary duties/responsibilities for this person
Repeat Training
Has this staff member previously attended training at ASPCA Spay/Neuter Alliance?
Clear selection
Staff #5 First Name
Staff #5 Last Name
Staff #5 Email
Please use a personal email address
Staff #5 Position
Clear selection
Time in Position
How long has this person been in this position, i.e., three months
Primary Duties
Please list primary duties/responsibilities for this person
Repeat Training
Has this staff member previously attended training at ASPCA Spay/Neuter Alliance?
Clear selection
Additional Comments
Submit
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