**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**
1
Do you possess a current license as Dietitian/Nutritionist from the Maryland Board of Dietetic Practice?
Yes
No
2
If you answered Yes to the previous question, please provide the license number and expiration date in the box below. A copy of your current license or license verification should also accompany your application.
3
Do you possess a Master's degree in Dietetics, Nutrition, Institutional Administration or other related field?
Yes
No
4
Describe your experience providing professional nutrition or dietetic services.
With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position. If you do not have this type of experience, put N/A in the box below.
5
Describe your nutrition/dietetic services experience in a residential or hospital setting.
Please include name of employer, job title, dates of employment, and hours worked per week for each relevant position. If you do not have this experience, put N/A in the box below.
6
Are you currently registered by the Commission on Dietetic Registration (CDR)? If yes, please submit proof of your current registration with your application. If no, you will be required to obtain registration prior to completion of the probationary period if selected.
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