HPEP Nevada WICHE/USU College of Veterinary Medicine Stipend Application — The Nevada Office of Western Interstate Commission for Higher Education (WICHE)

Step 1 of 13

Nevada WICHE Requirements and Upload of Required Documentation

Please read through the following statements and agree to the requirements of the NVWICHE/USU College of Veterinary Medicine Stipend.

Nevada Residency Requirement(Required)

I understand and agree to the following statement

You must be a Nevada resident for at least one (1) year prior to applying. You must maintain your Nevada residency while in a professional school.

Tuition Responsibility(Required)

I understand and agree to the following statement

If awarded, Nevada WICHE will work with USU College of Veterinary Medicine to disburse your stipend on your account. You will be responsible for the balance of tuition and fees as determined by your school.

Practice Requirements(Required)

I understand and agree to the following statement

You must physically reside in Nevada, and practice (employment) in the profession for which you received assistance upon graduation and licensure in your practice field. One year of full-time employment in your practice field is required for each year that you receive a stipend.

Stipend Conversion to Loan for Non-Fulfillment of Practice Obligation(Required)

I understand and agree to the following statement

If you do not fulfill the program’s practice obligation requirement your stipend will convert to a loan with accrued interest and applicable penalties. Nevada WICHE participants have up to one year after graduation to obtain their Nevada veterinarian practice license and employment. The participant has up to five years to fulfill their service obligation.

Practice Questionnaire Requirement(Required)

I understand and agree to the following statement

While you are a participant of the program, you are required to keep the Nevada Office of WICHE informed by completing the online Practice Questionnaire every six months. Along with the online Practice Questionnaire you will be required to attach supporting documentation to document that you are meeting program requirements. While in school you will need to provide a copy of your unofficial transcript (enrollment), Nevada driver’s license or Nevada Identification card (Nevada residency), and contact information. After you graduate you must provide our office with a copy of your employment verification letter to track the practice service hours completed, practice license, Nevada driver’s license or Nevada Identification card, and contact information.

Fall 2026 Acceptance letter Requirement(Required)

I understand and agree to the following statement

An Acceptance letter for fall 2026 from the USU College of Veterinary Medicine Four-Year Program must be uploaded as part of this application.

Nevada driver’s license or Identification Card Requirement(Required)

I understand and agree to the following statement

A current Nevada driver’s license or Nevada Identification Card to demonstrate residency must be uploaded as part of this application. To be eligible, your Nevada driver’s license or Identification Card must have an issue date of at least one year prior to submission of HPEP application.*

*If you have just renewed your license, please include a copy of the first page of your 2024 U.S. Federal Tax Return. The purpose is to comply with NRS 397.060 that requires applicants to have at least 1 year of residence in the state immediately before applying for program.

I understand and agree to all of the above condition(Required)

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Signature Date(Required)

MM slash DD slash YYYY

Required Documents

Please upload the following required documents:

Acceptance letter for fall 2026 from the USU College of Veterinary Medicine Four-Year Program.
Your current Nevada driver’s license or Identification Card

Please upload all required documents(Required)

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Biographical Information

Name(Required)

First Middle Last Suffix

Are you Authorized to Work in the United States of America?(Required)

Yes

Contact Information

Permanent Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you have an alternate address?(Required)

Yes

Alternate Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Phone Number(Required)

Alternate Phone Number

Primary Email Address(Required)

Alternate Email Address

Educational Background: High School

Name of High School(Required)

Location of High School(Required)

(City/State)

Dates Attended(Required)

Ex: Fall 2020 – Spring 2024

Year of Graduation (or date of GED)(Required)

Educational Background: College/University

College or University 1

Name of College or University(Required)

Location of College or University(Required)

(City/State)

Major(Required)

Dates Attended(Required)

Ex: Fall 2020 – Spring 2024

Did you graduate from this College or University?(Required)

Yes

Graduation Date(Required)

(ex: Spring 2025)

Credential Earned(Required)

Have you attended a second College or University?(Required)

Yes

College or University 2

Name of College or University 2(Required)

Location of College or University(Required)

(City/State)

Major(Required)

Dates Attended(Required)

Ex: Fall 2020 – Spring 2024

Did you graduate from the second College or University?(Required)

Yes

Graduation Date(Required)

(ex: Spring 2025)

Credential Earned(Required)

Have you attended a third College or University?

Yes

College or University 3

Name of College or University 3(Required)

Location of College or University(Required)

(City/State)

Major(Required)

Dates Attended(Required)

Ex: Fall 2020 – Spring 2024

Did you graduate from the third College or University?(Required)

Yes

Graduation Date(Required)

(ex: Spring 2025)

Credential Earned(Required)

Have you attended a fourth College or University?

Yes

College or University 4

Name of College or University 4(Required)

Location of College or University(Required)

(City/State)

Major(Required)

Dates Attended(Required)

Ex: Fall 2020 – Spring 2024

Did you graduate from the fourth College or University?(Required)

Yes

Graduation Date(Required)

(ex: Spring 2025)

Credential Earned(Required)

Personal Experience: Animal Experience

Enter experiences that relate to your choice to pursue becoming a veterinarian. Please enter all animal related experiences in the appropriate sections below.

Please Note

If you have additional experiences that you cannot list using the form there will be an opportunity to upload supplemental documents in the next step

Animal Experience 1

Animal Experience (no veterinarian involved, Volunteer or Paid)(Required)

Ex: Farm/ranch work involving animals, 4-H, working at an animal shelter, animal related research – field or laboratory based

Organization Name(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

What type of work did you do with this organization?(Required)

Volunteer

Paid

Responsibilities(Required)

Do you have a second example of Animal Experience?(Required)

Yes

Animal Experience 2

Animal Experience 2 (no veterinarian involved, Volunteer or Paid)(Required)

Ex: Farm/ranch work involving animals, 4-H, working at an animal shelter, animal related research – field or laboratory based

Organization Name(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

What type of work did you do with this organization?(Required)

Volunteer

Paid

Responsibilities(Required)

Do you have a third example of Animal Experience?(Required)

Yes

Animal Experience 3

Animal Experience 3 (no veterinarian involved, Volunteer or Paid)(Required)

Ex: Farm/ranch work involving animals, 4-H, working at an animal shelter, animal related research – field or laboratory based

Organization Name(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

What type of work did you do with this organization?(Required)

Volunteer

Paid

Responsibilities(Required)

Do you have a fourth example of Animal Experience?(Required)

Yes

Animal Experience 4

Animal Experience 4 (no veterinarian involved, Volunteer or Paid)(Required)

Ex: Farm/ranch work involving animals, 4-H, working at an animal shelter, animal related research – field or laboratory based

Organization Name(Required)

Organization Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

What type of work did you do with this organization?(Required)

Volunteer

Paid

Responsibilities(Required)

Supplemental Documents Related to Your Non-Veterinary Work With Animals

(Optional) Please upload any supplemental material related to your non-veterinary animal experience that could not be detailed using the form fields in the previous page.

Attach your documents

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Personal Experience: Veterinary experience

Enter experiences that relate to your choice to pursue becoming a veterinarian. Please enter all veterinary related experiences in the appropriate sections below.

Please Note

If you have additional veterinary experience that you cannot list using the form there will be an opportunity to upload supplemental documents in the next step

Veterinary Experience 1

Veterinary Experience 1 (with a veterinarian, Volunteer or Paid)(Required)

Ex: private practice or clinical medicine, animal health related research, veterinary public health

Veterinary Organization's Name(Required)

Veterinary Organization's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

Responsibilities(Required)

Do you have a second veterinary experience to add?

Yes

Veterinary Experience 2

Veterinary Experience 2 (with a veterinarian, Volunteer or Paid)(Required)

Ex: private practice or clinical medicine, animal health related research, veterinary public health

Veterinary Organization's Name(Required)

Veterinary Organization's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

Responsibilities(Required)

Do you have a third veterinary experience to add?

Yes

Veterinary Experience 3

Veterinary Experience 3 (with a veterinarian, Volunteer or Paid)(Required)

Ex: private practice or clinical medicine, animal health related research, veterinary public health

Veterinary Organization's Name(Required)

Veterinary Organization's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

Responsibilities(Required)

Do you have a fourth veterinary experience to add?

Yes

Veterinary Experience 4

Veterinary Experience 4 (with a veterinarian, Volunteer or Paid)(Required)

Ex: private practice or clinical medicine, animal health related research, veterinary public health

Veterinary Organization's Name(Required)

Veterinary Organization's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Start Date(Required)

End Date(Required)

Total Hours Accrued(Required)

Responsibilities(Required)

Supplemental Documents Related to Your Veterinary Experience

(Optional) Please upload any supplemental material related to your veterinary experience that could not be detailed using the form fields in the previous page.

Attach your documents

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Essay Questions

Please Provide a Succinct Answer to Each of The Following Questions, Limit of 2,000 Characters Per Question.

1. Why do you want to become a veterinarian and why do you feel that you would be an asset to the profession?(Required)

2. What are your long-term goals and career plans (specialization, advanced education, practice ownership, community involvement, large or small animal), should you receive Nevada WICHE financial support and become a veterinarian?(Required)

3. The Nevada Legislature appropriated the funds for a stipend to cover the difference between in and out of state tuition for 70 Nevada residents to earn a DVM at USU and return to Nevada to provide 4 years of service as a licensed Nevada Veterinarian. If you were selected to receive this HPEP stipend what does that personally mean to you?(Required)

4. What specific challenges and issues in Nevada do you believe will be the most important facing veterinarians in the coming years, and how do you plan to address these challenges in your future career?(Required)

5. After graduation, if you were offered a position with a competitive salary and benefits at a veterinary hospital in a rural part of Nevada would you take it? Please explain why or why not.(Required)

Acknowledgements

CONSENT TO TRANSFER STUDENT RECORDS THROUGH THE NEVADA OFFICE OF WESTERN INTERSTATE COMMISSION FOR HIGHER EDUCATION (WICHE)(Required)

I understand and agree to the student records policy

PURPOSE FOR REQUESTING STUDENT SIGNATURE ON CONSENT AND WAIVER FORM: Public Law 93-380, the Federal Family Education Rights and Privacy Act of 1974, requires all who hold custody of student records to insure protection of personally identifiable information. Administration of Nevada Office of WICHE Health Profession Education Program requires the exchange of educational information about student applicants in order to provide for consideration of enrollment and transfer of funds by the state in the case of admission by the school. In order to facilitate exchange of necessary documents, the student application is asked to sign a “Consent and Waiver” statement.

DESCRIPTION OF USE OF PERSONAL RECORDS: The program collects and uses information concerning student eligibility for the program; admission; enrollment; academic progress; graduation and/or termination from the professional program; and payment of fees by the State of Nevada through Nevada Office of WICHE to the receiving school. This information is exchanged between and among the Nevada Office of WICHE staff; Nevada System of Higher Education administrative staff assisting the Nevada Office of WICHE and the professional school(s) to which the student makes an application and is admitted. Periodic accounting for the Nevada Office of WICHE programs may result in publication of reports which contain year of enrollment, enrolling institution, and money spent by the Nevada Office of WICHE to support the student’s effort to reach an educational objective.

NOTIFICATION CONCERNING STUDENT ACCESS TO PERSONAL RECORDS: Any student participant or applicant for participation in the Nevada Office of WICHE Health Profession Education Program has access to their personal records maintained as a part of the exchange activity. If you want to review your record, contact the Nevada Office of WICHE that maintains the record to make appropriate arrangements. Nevada Office of WICHE has 45 calendar days to comply. The student participant may inspect and/or receive copies at a cost not to exceed the actual cost of reproduction. Per Nevada Revised Statute 239.080 the Nevada WICHE Commission/Nevada Office of WICHE state record retention schedule for applicant files that are unfunded are retained five (5) years and recipient files are retained for twenty (20) fiscal years after contract satisfaction. After the retention period has ended the records can be destroyed securely.

I understand that it is necessary to process student records in order to carry out the purpose of the Nevada Office of WICHE Health Profession Education Program, providing access to educational opportunities for Nevada residents.
I understand that the record-keeping process requires preparation, transmission, receipt, filing, and reporting of information appropriate to the effectiveness and continuity of the program.
I hereby consent to the transfer of personally identifiable educational records between and among the participants in the Nevada Office of WICHE Health Profession Education Program to include the following:
- Information concerning student eligibility, acceptance, and educational attainment.
- Information concerning fees paid by the Nevada Office of WICHE to the receiving school.
- Lists of applicants certified as eligible for support.
- Admissions reports, withdrawal reports, and annual reports for Nevada Office of WICHE Health Profession Education Program Participants.
- Admissions reports, withdrawal reports, and annual reports for Nevada Office of WICHE Health Profession Education Program Participants.
I understand that the information referred to herein will be available only to Nevada Office of WICHE Program staff members, Nevada System of Higher Education staff supporting Nevada Office of WICHE; designated institutional officials as required to carry out their official duties.

Signature(Required)

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Signature Date(Required)

MM slash DD slash YYYY

Acknowledgements (Cont.)

Confirmation of Practice Obligation and Possibility of Stipend Converting to a Loan(Required)

I confirm that I have read and understand the Nevada Office of WICHE Stipend Conversion to Loan for Non-Fulfillment of Practice Obligation Application Disclosure form.

If you do not fulfill your practice obligation your stipend will convert to a loan with penalties and interest. Due to this possibility, We are providing a link to a Nevada Office of WICHE Stipend Conversion to Loan for Non-Fulfillment of Practice Obligation Application Disclosure form.

The Truth in Lending Act (TILA), Title I of the Consumer Credit Protection Act, 15 U.S.C. § 1601 et seq., Regulation Z, 12 CFR Part 1026 requires lenders to provide clear and detailed information about the terms and costs associated with education loans, helping borrowers make informed decisions.

The Nevada Office of WICHE Stipend Conversion to Loan for Non-fulfillment of Practice Obligation Approval Disclosure form is an estimate* of the total loan amount, interest, finance charge, schedule of payments if the stipend amount received while in school is converted to a loan if you breach the terms of your stipend contract, for example by not fulfilling your practice obligation.

*Nevada WICHE recipients are not guaranteed a yearly stipend to complete their practice program. Selection of stipend recipients is based on eligibility (i.e., Nevada residency such as Nevada Driver’s License or Nevada Identification Card, acceptance to professional program), meeting compliance requirements (i.e., regular submission of Practice Questionnaire with supporting documents such as Nevada Driver’s License or Nevada Identification Card to demonstrate maintaining residency in Nevada, unofficial transcript for academic progress or Nevada Practice license, Nevada employer verification letter) as well as availability of funding from the Nevada Legislature.

Name

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