PNC.14.Application

PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP APPLICATION

for class starting in September 2021

PLEASE READ THE COMPLETE APPLICATION BEFORE STARTING. REFER TO THE CALENDAR ON OUR WEBSITE.

PNCDDI.COM

Please see the "Finding Preceptors and Sites" tab on our website for helpful hints.

PLEASE SUBMIT YOUR COMPLETED APPLICATION ONLINE BY CLICKING THE SUBMIT BUTTON ON THE BOTTOM OF THE PAGE. THERE IS A NON-REFUNDABLE APPLICATION FEE OF $75 WHICH MAY BE PAID BY CREDIT or DEBIT CARD AT THE END OF THIS APPLICATION WHEN YOU SUBMIT IT . YOU WILL BE DIRECTED TO A PAYMENT LINK AFTER CLICKING SUBMIT.

LAST NAME *

FIRST NAME *

Current Address # and Street *

City or Town *

State *

Zip Code *

Cell phone *

Your E-Mail address *

In what state will you be living during your Internship ?

Do you have materials under another name? *

Yes No

If yes, what is the name?

At what school did you complete or are you completing your DPD Program ? *

Please check all that apply : (requirement is a Bachelor's Degree ONLY) *

I have completed my Bachelor's Degree. I am currently working on my Bachelor's Degree I have completed a Master's Degree I am currently working on a Master's Degree I have completed or I am working on a Ph.D. I am an NDTR. I am planning to take the NDTR exam.

If you are an NDTR, what is your number?

Did you receive a Verification Statement ? *

Yes No

What was the date of DPD completion on the statement ? *

Did you receive a Declaration of Intent ? *

Yes No

When will you complete your DPD ? *

Have you already received commitments from one or more Preceptors to work with you ? *

Yes No

If yes, how many ?

1 2 3 4 more than 4

If yes, in what areas ?

Clinical Community Food Service Management

I understand that my attendance at the 3 day online orientation is required to participate in this Internship. *

Yes No

Have you ever been convicted of a felony or any other offense against the law other than a minor traffic violation ? *

Yes No

If yes, please explain here.

Have you ever been accepted and then declined an Internship offer ? OR have you ever been in an Internship and not completed for ANY reason ? *

Yes No

If yes, please explain here.

How did you find out about our Program ? Please check all that apply. *

If you learned about our Program from one of our current Interns or a Program graduate, please provide the person's name.

Is this the first time you have applied to a Dietetic Internship ? *

Yes No

Have you ever declined an Internship position that was offered to you or withdrawn or been asked to withdraw from an Internship ? *

Yes No

If yes, please explain below.

Why are you applying to a Distance Dietetic Internship ?

ADDITIONAL INFORMATION If you wish to attach a statement indicating why we should consider your application if you do not meet the preferred requirements for Admission (i.e.GPA, experience etc.) please attach here.

PLEASE READ THE FOLLOWING VERY CAREFULLY.

1. I understand that if matched, I will be required to submit to a background check which will include criminal and drug/substance of abuse screening.

2. An adverse finding in the criminal background check will result in a withdrawal of the offer of an Internship with the Priority Nutrition Care Distance Dietetic Internship.

3. A drug/substance check with a finding other than negative, will result in dismissal from the Internship.

4. In either case, all monies paid will be forfeited.

5. I understand that no additional drug/substance testing will be considered if a drug/substance screen that is not negative is verified.

6. I understand that any negative change in criminal background or a drug/substance test with a result that is not negative received at any time during the internship will result in dismissal from the Internship and forfeiture of all monies paid.

7. I understand that if matched, I will be required to submit medical/physical forms including typically required immunizations.

8. Failure to submit these forms in a timely manner will result in termination from the Internship.

9. I understand that these required immunizations, physical exam and other mandatory requirements (for example health insurance) must remain current and that it is my responsibilty to keep them current. Failure to do so will result in termination from the Internship.

10. I understand that I must provide all requested documents to the Internship when requested, either directly, or through an intermediary designated by the Internship, including but not limited to proof of insurance, (health, malpractice and professional liability), verification statements and transcripts. Failure to do so will result in termination from the Internship.

11. I understand that my preceptors will be required to complete Preceptor forms found under the Preceptor tab on the website, as proof that they have agreed to precept me and to attest to their qualifications.

12. I understand that this application will not be complete and will not be considered unless I continue to the payment page and complete the payment process.

13. I understand that tuition will be payable in full, two equal installments or a five installment automatic withdrawal payment plan commencing 7days after acceptance to the Program. Full and half tuition payments may be made by credit card or personal check. The five payment plan must be paid through an automatic debit/credit card withdrawal.

Tuition is $11,750. There is a deposit required of $1820, within 24 hours of publication of the match or acceptance to the Internship, if accepted in the second round. The deposit must be paid by credit card or debit card (and includes a bank convenience fee).

Tuition payments may be paid by check, credit card or debit card. There is a bank convenience fee associated with credit/debit card payments in the amount of $250 for each installment when paid in two installments or $500 for payment in full. Convenience fee for the automatic withdrawal ten payment plan is $500.

14. I understand that there is no financial aid provided for this program by Priority Nutrition Care LLC. On request, and after tuition is paid in full, the program will provide a letter to matched/accepted Interns attesting to the fact that he/she is in the program and that completion is required to establish eligibility to take the examination to become an RD/RDN, which is required to practice as a Registered Dietitian/Nutritionist. This letter MAY be considered by the lender to allow you to defer education loan payments.

15. I understand that I am responsible to find my own sites and that it is not guaranteed that contractual arrangements can be reached with all facilities.

16. I understand that due to effects of the pandemic, the Internship may have to make changes which impact rotation schedules and delivery of education and I agree to abide by the policies related to any such changes.

I understand and agree to the previous statements. *

Yes No

I understand that my application fee is non-refundable. *

Yes No

I understand that should I be accepted to Priority Nutrition Care Dietetic Internship and accept the offer of admission, I will be financially obligated to pay 100% of the tuition and fees owed. *

Yes No

I understand that should I be accepted to Priority Nutrition Care Dietetic Internship and accept the offer of admission, all monies paid after that date will be non-refundable. *

Yes No

Signature (please type) Your signature indicates acceptance of the above terms. *

You will be directed to a link to pay the $75 nonrefundable application fee after clicking the submit button below.

Name of person on credit card used for payment, if different from your own.

Enter the message as it's shown *

PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS BEFORE CLICKING THE SUBMIT BUTTON.

YOU WILL RECEIVE AN EMAIL WITH LOGIN INFORMATION AFTER SUBMITTING YOUR PAYMENT. PLEASE RETAIN THAT LOGIN INFORMATION FOR USE AFTER THE MATCH.