Applicant's name:_______________________________________

Please print and attach checklist to completed application

1. Hand written letter of application

2. ADA Dietetic Internship Application Form

3. Official transcript(s) from all colleges or universities attended

4. Copy of university approved DPD requirements with course substitutions listed.

5. Verification Statement of DPD coursework or Declaration of Intent.

6. Reference letters (3) each accompanied by or incorporated in ADA Recommendation Forms for Dietetic Internship Appointments.

7. Audiotaped message by candidate using standard size audiotape cassette.

8. Application fee ($40.00)

9. Please make sure that you have specified the computer matching code for your appointment date as:

SEPTEMBER: 395 (full-time) and 497 (part-time, available this year)
You must select one option.

10. Phone number and address where applicant can be reached on the April match day.

Phone # _______________________________________________

Address _______________________________________________

Sue Kent, MS, RD, LD, Education and Research Manager
Phone: 216-444-6487, [email protected]