APPLICATION FORM FEI OFFICIAL VETERINARIAN

Transcription

1 INFORMATION PAGE: OFFICIAL VETERINARIANS INTRODUCTION This form should be completed by Veterinarians applying to their National Federation for nomination to the FEI Veterinary Committee for promotion to FEI Official Veterinarian. From 2013 all veterinarians wishing to be promoted as an FEI Official Veterinarian (OV) must first become listed as a Permitted Treating Veterinarian. Applications may be submitted to the National Federation of the veterinarian s citizenship or residency, in accordance with the General Regulations. Please check the current requirements for promotion to FEI Official Veterinarian in the FEI Veterinary Regulations before completing this application form. Completed applications by the National Federation are to be sent to veterinaryeducation@fei.org. MINIMUM ENTRY REQUIREMENTS FOR OFFICIAL VETERINARIANS (refer to the current Veterinary Regulations for full information) Permitted Treating Veterinarian Attended a 2 day FEI Veterinarian Course, in the 2 years before submitting an application Have 5 years post qualification equine veterinary experience Completed mentoring and supervision at a minimum of three FEI Events (10 for Endurance) ROLES OF S National Head FEI Veterinarian (formally Contact Veterinarian) (NHV) Veterinary Delegate (VD) Foreign Veterinary Delegate (FVD) Assistant Veterinary Delegate (AVD) Endurance Veterinary Treatment Official (EVT) Testing Veterinarian Holding Box Veterinarian (previously Examining Veterinarian) Measuring Veterinarian Examining Veterinarian (Limb Sensitivity) Application Checklist (Please tick the appropriate answer) Yes No I have attended a FEI Veterinarian Course in the past 2 years I acknowledge and accept the FEI Official Veterinarian Codex I have included contact details for 3 (or in Endurance 10) mentors I have at least 5 years post-qualification equine veterinary experience I have attached statements from the mentoring Veterinary Delegates FEI Official Veterinarian Application Form Page 1 of 5

2 SECTION ONE To be completed by the applicant for FEI Official Veterinarian. PERSONAL INFORMATION FEI ID: First Name: Family Name: Address: address/s: Telephone Number: Date of Birth: National Federation: DISCIPLINE(S) REQUESTED FOR PROMOTION Jumping Dressage Eventing Driving Vaulting Endurance Reining Para-Dressage SECTION TWO QUALIFICATION EXPERIENCE FEI COURSES/ SEMINARS (past five years) DATE PLACE TYPE COURSE DIRECTOR FEI Official Veterinarian Application Form Page 2 of 5

3 FEI EVENT: VETERINARIAN EXPERIENCE DATE PLACE EVENT TYPE (discipline & starrating) EVENT CODE MENTOR NAME MENTOR FEI ID REMARKS Please ensure a short signed statement is provided from each Veterinary Delegate/ Mentor named above, these must be submitted with this application. FEI Official Veterinarian Application Form Page 3 of 5

4 SECTION THREE DECLARATION: APPLICANTS Applicants requesting nomination from their National Federation for promotion as an FEI Official Veterinarian are required to sign the following declaration. DECLARATION FOR APPLICATIONS I confirm the following: 1. The information provided in Section One of this application for nomination and promotion to FEI Official Veterinarian is true 2. I am a listed FEI Permitted Treating Veterinarian 3. I have read and understood the FEI Code of Conduct 4. I have read and understood the current version of the FEI Veterinary Regulations 5. I have read and understood the current version of the FEI Equine Anti-Doping and Medication Control Regulations (EADMCR) 6. I am aware of the contents of the FEI Clean Sport webpage and the Veterinary section of the FEI webpage. 7. I acknowledge and accept the FEI Official Veterinarian Codex Name: Date: Applicant Signature: Please send your completed application form to your National Federation via Fax, Post or electronically by . For electronic submissions please ensure a scanned copy containing your signature is submitted. Contact details for your National Federation can be found on the FEI webpage under National Federations. FEI Official Veterinarian Application Form Page 4 of 5

5 SECTION FOUR NATIONAL FEDERATION USE ONLY PROMOTION FOR Applicant Name Applicant FEI ID FOR NATIONAL FEDERATION USE ONLY We hereby certify that the information above regarding the above named applicant for FEI Official Veterinarian is correct and true. We hereby declare our wish to nominate this Permitted Treating Veterinarian to the FEI Veterinary Committee for promotion to FEI Official Veterinarian in the following disciplines: Jumping Dressage Eventing Driving Vaulting Endurance Reining The National Federation will be charged 40CHF for the Official Veterinary Delegate stamp. NF Representative National Federation Official Stamp Signature Date FEI Official Veterinarian Application Form Page 5 of 5