Section Pos 1601.04 - Application(a) Each applicant for tuition repayment under this program shall make application on Form PEC-vet, application for large animal veterinarian tuition repayment, by supplying the following information:(1) His or her first name and last name;(2) Applicant's current address;(3) Applicant's current license number;(4) Address of veterinary practice;(5) Counties served by the practice;(6) Beginning and ending date of service for which an award is sought; and(7) Statement detailing total hours devoted to the practice in the prior year and the total hours that were devoted to large animals over that same period.(b) The application shall be signed and dated by the applicant.(c) The applicant shall attach copies of bills, or receipts, detailing the tuition paid for training as a large animal veterinarian for which the applicant is seeking repayment.(d) The applicant shall provide evidence of licensure as a veterinarian in the state of New Hampshire.N.H. Admin. Code § Pos 1601.04