MISSISSIPPI BOARD OF
VETERINARY MEDICINE
1089D STARK RD
STARKVILLE, MS39759
PHONE: 662-324-9380
FAX: 662-323-9921
EMAIL:
APPLICATION FOR CERTIFICATION OF NAVLE ELIGIBILITY
AND STATE EXAMINATION FOR LICENSE
Full Name:Mailing Address:
City: State: ZIP:
Phone: Email address:
Social Security #: Date of Birth:
I am currently enrolled as a senior student of veterinary medicine and surgery at:
______MississippiStateUniversity
______Other (please list) ______
Date of or anticipated date of graduation is ______(month, day),______(year).
Date:______Applicant’s Legal Signature:______
Date:______Secretary or Dean’s Signature:______
One (1) Photo (passport size) is required.
Please print your name on the back of the photo.
This form must be returned to the Mississippi Board of Veterinary Medicine by 12:00 noon, January 3, 2018in order to be eligible to take the NAVLE in April, 2018 testing window.
This form must be returned to the Mississippi Board of Veterinary Medicine by 12:00 noon, August 1, 2017in order to be eligible to take the NAVLE in November/December 2017 testing window.
IN ACCORDANCE WITH THE AMERICANS WITH DISABILITIES ACT, ANYONE REQUIRING SPECIAL ACCOMMODATIONS DURING THE EXAMINATION SHOULD NOTIFY THE BOARD AT 662-324-9380.
CERTIFICATION OF NAVLE ELIGIBILITY AND STATE BOARDS
Application/Certification Fee$200.00
Check or money order made payable to: Mississippi Board of Veterinary Medicine or MBVM
* * * FEE IS NON-REFUNDABLE * * *
Important Note: Applicants interested in taking the State Board Examination for licensing in Mississippi must attach legal signature below. There are no additional fees for the Examination, as it is covered in the application/certification fee. You will receive notification as to the next available examination upon receipt of your application and signature.
I wish to take the Written and Oral Examination for licensing in Mississippi.
______
Legal Signature Print Name as you wish it to appear on License
______
Date
NAVLE TESTING WINDOWS
NOVEMBER 12– DECEMBER8, 2017 APRIL8 - 20, 2018
ABulletin of Information for Candidates, which contains the NAVLE Application and Reporting Forms with instructions on registering for the Testing Windows listed above is available at NBVME (National Board of Veterinary Medical Examiners) must receive your completed application and fee ninety two (92) days prior to the opening of the testing window. (This goes for the April testing window also if you will be taking NAVLE for the first time during that window.)
The Mississippi Board office will only be responsible for certification to NBVME regarding your eligibility. Submitting your application in a timely manner will ensure that you meet the deadlines set by the NBVME. It is recommended that you obtain your certification from this office as soon as possible.*
*Applicants not seeking licensure in Mississippi are urged to contact that jurisdiction in which they are seeking licensure to obtain certification of eligibility for the administration of the NAVLE.