DIETETIC INTERNSHIP (DI) APPLICATION

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Department of Dietetics & Nutrition Instructions: DIETETIC INTERNSHIP (DI) APPLICATION 1) Applications must be TYPED and all requested information must be submitted by July 1 st or December 1 st. Should the due date fall on a weekend or holiday, the application will be due the Friday before the due date. All applicants MUST be currently enrolled in a graduate program in the Department of Dietetics & Nutrition at the time of the application to the Internship Program. Incomplete applications will not be considered for review for the Internship Program. Students may only apply twice. 2) Official Transcripts: If any courses are taken at another accredited university to fulfill didactic requirements those official transcripts need to be submitted to the Office of Graduate Admissions, Florida International University. The official transcripts in your Florida International University record will be referenced when evaluating your application. 3) Eligibility for Application: All applicants must meet with their advisor to determine their eligibility to apply: a) Didactic Program in Dietetics (DPD) Declaration of Intent and Verification Statement. If DPD coursework is not completed, a DPD Declaration of Intent must be submitted with the application. If DPD coursework is completed, a DPD Verification Statement issued within five years must be submitted with the application. YOU MUST HAVE A DPD VERIFICATION STATEMENT TO START THE INTERNSHIP. b) Graduate courses: have 9 credit hours remaining, none of which are DPD requirements. c) Master s thesis or project requirement: a first draft of project/thesis must be given to the major professor. Doctoral students must have completed data collection. Signature of your major professor is required on the application form. Professor s signature denotes that the thesis/project requirements are met. d) The Dietetic Internship Program will not consider applicants who: Have received lower than a C in any Florida International University undergraduate science course and DPD course or its transfer equivalent. Have received more than two grades of C+ in graduate courses. Applicants should have an overall graduate GPA of 3.0 or above at the time of application to the DI and at the start of the internship. Not having a 3.0 GPA at the start of the internship will result in dismissal from the program. 4) Recommendation Forms: Select two individuals to complete the Recommendation Forms. At least one should be able to evaluate your knowledge of dietetics and nutrition. The visibility rights portion (1 st page) needs to be completed prior to giving the form to the recommender. The recommender may choose to send a personal letter but the Recommendation Form Rating Checklist must be completed. If the reference includes a letter, the letter MUST be on official letterhead stationary. Each recommendation must be in a sealed envelope with the writer's signature on the seal. These persons should be familiar with your academic ability and work performance and

cannot be related to you. The DI Director or the DI Admissions Committee members will not write letters or recommendations. The form may be found here (link inserted). 5) Complete Background check, FBI level 2 and Fingerprinting: The internship applicant must submit with the application a copy of their COMPLETED Level II FBI Background Check including the Finger-Printing completed by American DataBank through http://fiuexpress.com/. The student is responsible for any costs that this requirement incurs. (NOTE: THIS PROCESS CAN TAKE UP TO 3 WEEKS) CHECKLIST YOUR APPLICATION WILL NOT BE CONSIDERED IF ANY COMPONENT IS MISSING 1. Typed completed DI program Application form 2. DPD course list form provided by DPD Director 3. Unofficial transcripts and translations (if applicable) for DPD courses 4. GPA calculation worksheet 5. Personal Statement 6. Two completed Recommendation Forms 7. DPD Declaration of Intent or Verification Statement 8. Completed background check, FBI level II and Fingerprinting THE COMPLETED APPLICATION PACKET MAY BE MAILED OR BROUGHT TO THE PROGRAM ASSISTANT IN THE DEPARTMENT ON OR BEFORE THE DUE DATE. DI PROGRAM ASSISTANT Department of Dietetics & Nutrition Florida International University Modesto A. Maidique Campus, AHC 5-305A 11200 SW 8 th Street Miami, FL 33199

I (Student Name and PID) Department of Dietetics & Nutrition COVER PAGE understand the following policies and procedures regarding this application: 1. IN ORDER TO BEGIN THE DIETETIC INTERNSHIP STUDENTS MUST: a. Have completed ALL their didactic course requirements and have a DPD verification statement. b. Have completed ALL the MS course requirements. c. Complete the MS thesis/project requirement, including presentation in Graduate Seminar (DIE 6937). 2. The student will be responsible for his/her own transportation to the supervised practice site. Students assume all liability for safely traveling to and from assigned areas. 3. The DI is designed for FIU graduate degree-seeking students only. 4. Before supervised practice begins, each student will need to provide documentation: a. Vaccinations, including varicella titer, PPD X 2, MMR, and tetanus vaccines. b. Level II FBI background check including finger-printing. c. Active adult CPR certification (only by American Heart Association). d. A 10-panel drug test could be required by the placement facility. The Program Director or Coordinator will inform you if a 10-panel drug test is required. If required, you will need to complete it within 30 days of beginning the practicum. The student is responsible for any costs that the above requirement incurs. Details and appropriate forms will be provided to the student by the Program Director or Coordinator. 5. The DI applicant must submit with the application a copy of the COMPLETED Level II FBI Background Check including the Finger-Printing completed by American DataBank. The student is responsible for any costs that this requirement incurs. The DI applicant understands that final admission to the DI is contingent on the outcome of their background check. 6. There is an additional fee of $50 per credit hour assessed for internship classes, for the purpose of meeting the expenses associated with the internship education. 7. Students must abide by the Academy of Nutrition and Dietetics Code of Ethics for the Profession of Dietetics. Students must also abide by the standards as discussed in the FIU DI Handbook. Students will not be admitted into the DI if their conduct does not meet these codes. During the Dietetic Internship, any student who does not perform in accordance to applicable policies and procedures as outlined in the DI Handbook may be removed from the Dietetic Internship Program. I have read the above statements and agree to abide by the requirements. The information included in my application is true and accurate and can be verified. If I fail to comply with the requirements of the Dietetic Internship, I forfeit my acceptance into the internship. (Student's Signature) (Date) _ (Dietetics and Nutrition Department Witness) (Date)

PERSONAL INFORMATION Panther ID: Name: Last First Middle Address: City: State: Zip Code: FIU email address: Home Telephone Number: Non-FIU email address: Cellular Telephone Number: Have you ever been charged or convicted of a misdemeanor and/or felony? YES NO If yes, explain briefly: ALL UNIVERSITIES/COLLEGES ATTENDED (chronological order): Institution City/State Major Degree Granted Date Were you ever required to leave any university, college, or professional school OR denied readmission because of deficiencies in either conduct or scholarship? YES NO If yes, explain briefly:

Graduate Courses remaining after DI application submission: Course # Course Description Credits Major Professor s Information ONLY IF COMPLETING THESIS OR PROJECT REQUIREMENT The Major Professor s signature assures the DI Program Director that the student has discussed with the advisor his/her intention to begin the supervised practice. All graduate requirements must be met before the student begins the supervised practice. This signature is required at the time of application submission to the Internship Program. Major Professor s Name (printed): Major Professor s Signature: Date: GRADE POINT AVERAGE (GPA) When completing these calculations please refer to the GPA worksheet at the end of the application. Science GPA: Dietetics/Nutrition GPA:

EMPLOYMENT and VOLUNTEER ACTIVITIES Please list the employment/volunteer activities that you have participated in within the last 5 years in chronological order with the most recent activity within each category listed first. Leave sections blank if you do not have an activity to list in that category. Dietetics Experience: (Examples: Any clinical, community or food service/food management experience; dietetics & nutrition research) Location Starting Date Ending Date # Hrs/Wk Hours Clear description of position and duties Health Experience: (Examples: Experiences working/volunteering at medical establishments such as clinics, hospitals, pharmacies) Location Starting Date Ending Date # Hrs/Wk Hours Clear description of position and duties Other Experience: (Examples: Any retail experience; accounting & management) Location Starting Date Ending Date # Hrs/Wk Hours Clear description of position and duties PROFESSIONAL ORGANIZATIONS and CONFERENCES Please list membership in professional organizations and conferences attended for the last 5 years in chronological order starting with the most recent first. Name of Professional Organization/ Conference Dates attended (from mm/yyyy to mm/yyyy) Hours Clear description of Role

PERSONAL STATEMENT Provide a personal statement which includes the topics listed below for aspiring to become a Registered Dietitian and be selected for the FIU Dietetic Internship. This written statement will be evaluated for organization, content, individuality, spelling/grammar, connection to the profession of dietetics, and length/format. A maximum of two typed pages with 12 point font, 1.5 spacing, and 1 margins is required. Career Choice Describe (include examples) how your attitudes, values, skills, and character demonstrate your ability to: enter the dietetics profession make the profession right for you Self-Direction and Productivity Describe (include examples) how your accomplishments and contributions demonstrate your ability to: set goals for yourself work independently manage multiple responsibilities bring projects to closure Interpersonal Skills Describe (include examples) how your accomplishments and contributions demonstrate your ability to: demonstrate sensitivity or adaptation to a variety of people and situations participate in a team effort use constructive criticism for self-improvement Leadership Describe (include examples) how your accomplishments and contributions demonstrate your ability to: organize and motivate others to accomplish goals play a leadership role in academic, extracurricular, or community settings Self-Evaluation Describe (include examples) how your accomplishments and contributions demonstrate your ability to: self-evaluate identify your strengths identify areas where you need to improve Internship Choice Indicate and explain your reasons for selecting the Dietetic Internship at Florida International University in relation to your professional goals.

CRITERIA FOR SELECTION OF STUDENTS Applications are due in the Department of Dietetics and Nutrition by 5 pm on the assigned date (July 1st or December 1st) - no exceptions will be made. Should the due date fall on a weekend, the application will be due the Friday before the due date. The admission criteria are specified and weighted in the following point system. Do not complete this section; it is for your information only. Criteria Points (100 points total) 1. Science GPA 3.00-3.33 5 points 3.34-3.67 10 points 3.68 4.00 15 points 2. Dietetics GPA 3.00-3.33 15 points 3.34-3.67 20 points 3.68 4.00 25 points 3. Employment/Volunteer Activities Employment/Volunteer Activities.. 10 points (maximum) 4. Professional Organization Involvement Professional Organization Involvement. 5 points (maximum) 5. Personal Statement Content, professionalism, clarity, grammar and spelling. 20 points (maximum) 6. Recommendation Forms... 10 points (maximum) 7. Committee Evaluation. 15 points (maximum) Faculty Evaluation of Applicants Department faculty members who have taught, advised, or supervised applicants may be invited to complete the Recommendation Form Rating Checklist. The DI Program Director, Program Coordinator or Admissions Committee members will NOT write letters of recommendation for students applying to the program.

GPA Worksheet Please use the following information to calculate your DPD Professional and DPD science grade point averages (GPA). This worksheet must be typed and turned in with your application. GPA = (Grades x Credits)/Credits A 4.00 A- 3.67 B+ 3.33 B 3.00 B- 2.67 C+ 2.33 C 2.00 C- 1.67 D+ 1.33 D 1.00 F 0.00 Things you will need to complete this worksheet: Unofficial transcripts DPD course list form provided by your DPD director Calculator DPD Course List: The DPD Director will complete the DPD Course List form based on the program requirements for the catalog year in which the applicant s degree is being evaluated, and will record the catalog year on the form. (In most instances, the catalog year is the year the applicant entered the DPD program, i.e., Fall 2012.) o If a program has more than one track or option to earn a DPD Verification Statement, the DPD Director will complete a course list for the track the applicant is completing or completed. o DPD Directors should provide alumni with DPD Course List forms that correspond with the plan of study when the alumni completed the program. The DPD Director classifies all courses as either DPD Professional or DPD Science on the Course List form. Once completed, the DPD Director will provide the form back to the applicant. o If an applicant has taken a course at another institution that fulfills one or more course requirements in the catalog, list only the required course from the catalog.

Step 1: Complete the Course List Table: In order to complete this section of the worksheet, applicants should use the DPD course list form provided by their DPD directors. The applicant should enter their courses in the spaces provided below and turn in the DPD course list form with their application so that the Dietetic Internship Committee can cross check and confirm coursework was categorized correctly in this section. Example Course List Table: DPD Science Courses Credits DPD Professional Courses Credits General Chemistry I/Lab 4 Principles of Nutrition 3 General Chemistry II/Lab 4 Life Cycle Nutrition 3 Organic Chemistry I/Lab 4 Food Science/Lab 4 Organic Chemistry II/ Lab 4 Institutional Food Service Production 3 Microbiology/Lab 4 Advanced Nutrition 3 Intermediate Physiology 3 Medical Nutrition Therapy/Lab 4 Biochemistry 3 Clinical Nutrition/Lab 4 Nutrition Counseling/Lab 4 Nutrition Education/Lab 4 Dietetics in Community Health 3 Management of Dietary Systems/Lab 4 Applied Management of Nutrition 4 Programs/Lab Evidence Based Research in Dietetics 3 Seminar in Dietetics and Nutrition 3 Course List Table: DPD Science Courses Credits DPD Professional Courses Credits

Step 2: Complete the DPD Science GPA Calculation Table Applicants should complete the table below by entering accurate information from the course list table above and their unofficial transcripts into each of the columns. Example: DPD Science Course Letter Grade Points Credits General Chemistry I A 4.0 3 12.0 General Chemistry I Lab B- 2.67 1 2.67 Credits: 4 14.67/4 = 3.67 DPD Science GPA: 3.67 DPD Science Course Letter Grade Points Credits Points x Credits Points x Credits: 14.67 Points x Credits Credits: Points x Credits: Points x Credits/ Number of Credits = DPD Science GPA DPD Science GPA:

Step 3: Complete the DPD Professional GPA Calculation Table Applicants should complete the table below by entering accurate information from the course list table above and their unofficial transcripts into each of the columns. DPD Professional Courses Letter Grade Points Credits Points x Credits Number of Credits: Grade Scale Points x Credits: Points x Credits/ Number of Credits = DPD Professional GPA DPD Professional GPA: