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#23-002771-0001
Supplemental Questionnaire

Last Name
First Name

 

***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/Nutritionist from the Maryland State Board of Dietetic Practice? If yes, please indicate the license number and expiration date. If no, enter N/A.

2.

Do you possess a current ServSafe Certification? If yes, in the box below please provide the date the ServSafe certification was issued.  If you do not possess the certification, indicate NA.

3.

Describe your experience using the Nutrikids software to analyze menus. Include in your response the employer name(s), hours worked, and dates of employment, and detail/specify the specific functions you performed. If you do not possess this experience, please indicate N/A.

4.

Describe your experience implementing the Federal Child Nutrition Program regulations. Include the name of the employer, dates of employment, and hours worked per week performing this task.


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