**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 a Dietitian or Nutritionist from the Maryland State Board of Dietetic Practice? If YES please include your license number and expiration date in text box. Also, please upload copy of license to your application.
2.
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.
Yes
No
3.
Describe your experience providing professional nutrition or dietetic services in a residential or hospital setting.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
4.
Describe your experience managing a clinical and administrative phase of a dietetic program.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
5.
Describe your experience working in a psychiatric setting.
With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position. This experience must also be reflected in the "Work Experience" section of your application. If you do not have this experience, put N/A in the box below.
6.
Describe your experience complying with standards set by the Joint Commission, centers for Medicare and Medicaid services, and Office of Healthcare Quality.
This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.
Department of Budget and Management