(A) A veterinarian who has not received student loan repayment assistance pursuant to federal law and who meets either of the following requirements may apply for participation in the veterinarian loan repayment program:

1. (1) The veterinarian is enrolled in the final year of a veterinary medical program at a veterinary college approved by the state veterinary medical licensing board or accredited by the American veterinary medical association.
2. (2) The veterinarian has been engaged in the practice of veterinary medicine in this state for not more than three years prior to submitting the application.

(B) An application for participation in the veterinarian loan repayment program shall be submitted to the board on a form that the board shall prescribe. The application shall include the following:

1. (1) The applicant's name, permanent address or address at which the applicant is currently residing if different from the permanent address, and telephone number;
2. (2) The veterinary college the applicant has attended, the dates of attendance, and verification of attendance;
3. (3) A summary and verification of the educational expenses for which the applicant seeks reimbursement under the program;
4. (4) In the case of an applicant who is eligible to apply because the applicant is a veterinarian who has been engaged in the practice of veterinary medicine in this state for not more than three years prior to submitting the application, verification of the applicant's authorization under this chapter to practice veterinary medicine;
5. (5) Verification of the applicant's United States citizenship or status as a legal alien.