PNC 18.Overview Rotation Schedule

25 week ROTATION & PRECEPTOR INFORMATION SCHEDULE

June 2023 Class

The information you submit on this form will be used to send information about the Internship needed by your Preceptors and Contracts to the appropriate parties.

EVERY TIME YOU MAKE A CHANGE IN A PRECEPTOR OR ROTATION YOU MUST SUBMIT THIS FORM.

Please note: If you are adding, deleting or changing information please describe the change(s) you have made in the box below AND make the changes further down on the form itself.
PLEASE READ THIS ENTIRE FORM BEFORE YOU START

Please complete this form about your preceptors and planned schedule for whichever preceptors and rotations you have identified to date. THE ELECTIVE ROTATION DOES NOT NEED TO BE IDENTIFIED UNTIL LATER IN THE PROGRAM. It is essential that you follow directions explicitly.

You will receive an email at the email address you provide below with a copy of this form. It will have an EDIT button in the upper left which will allow you to EDIT this form. PLEASE SAVE THAT EMAIL. We do not have access to that link. If you do not have it, you will need to complete the form again in full.

All questions require a response. Therefore, even if you do not have all of your preceptor information, please fill in with NA or random numbers.
YOUR Name*

Last Name First Name
YOUR E-mail*
I have made a change(s) to my schedule.*

YESNO
What changes have you made ? Check all that apply.*

Add a new rotation siteDelete a rotation siteChange a rotation siteAdd or change a PreceptorThis is my first submission after acceptance to PNC
To which Rotation(s) have you made additions, deletions or changes. Check all that apply*

1234NA
Respond below to specifically what edits/changes have you made to your previous rotation schedule and why? Please be very specific. If this is a first submission, please say so.

Please include Rotation numbers, names of facilities, preceptors etc.

Describe specifically why you want to make this change.

Please note that you MUST have approval from the Internship before making a CHANGE in a site or preceptor that has already been approved. This change would be requested by submitting this form. It may be denied.

Adding a site does not require prior approval. You MAY NOT make a change because you got a "better offer" or more interesting opportunity. Preceptors plan long and hard to have Interns and professional protocol requires that AFTER approval is given, the preceptor MUST be notified that you will not be attending that site or conversely, you must continue to communicate with an approved site and not just make the arrangement and have no further contact until close to your arrival. They may forget about you.

If this is your first submission after acceptance to PNC say "First schedule".
Respond here*
Today's Date*

MonthDay Year
YOUR CELL*

Area Code Phone Number
Address during Internship*

Street Address
Street Address Line 2
City State
Zip Code
YOU MAY CHOOSE ONE SITE PER ROTATION. PLEASE COMPLETE THE FOLLOWING INFORMATION ABOUT YOUR SITES AND PRECEPTORS. THE INFORMATION ON THE ELECTIVE PRECEPTOR DOES NOT NEED TO BE FILLED OUT UNTIL YOU ARE HALF WAY THROUGH OUR PROGRAM AND THE PROGRAM REQUESTS THE INFORMATION.

PLEASE NOTE:

ALL Rotation Sites must be IN PERSON. Please see our website for more information on rotation sites.

CLINICAL ROTATION
- PRECEPTOR MUST BE AN RDN FOR THE ENTIRE ROTATION.
- MAY BE INPATIENT OR OUTPATIENT.
COMMUNITY ROTATION
- IF YOU HAVE WORKED AT WIC PREVIOUSLY, PLEASE CHOOSE ANOTHER SITE FOR YOUR COMMUNITY ROTATION.
FOOD SERVICE ROTATION
- IF IN A SCHOOL SYSTEM, IT MUST BE A PUBLIC SCHOOL "SYSTEM".
THE FOLLOWING SITES WILL NOT BE APPROVED:

Private Practices (RDNs or MDs)

Gym/Personal Training businesses

Psychiatric Programs incuding Eating Disorder facilities

Substance Abuse Programs

Sites which run their own Dietetic Internships

Remote sites - You may not work from home.

Hybrid Arrangements
Please consult Rotation Calendar on PNCDDI.com.
ROTATION 1
6/14/23 through 7/28/23
Rotation 1 will start 3 days earlier than originally planned to ensure completion time.
Rotation 1: TYPE OF ROTATION*
Full Legal Name of Facility*
Address*

Street Address
Street Address Line 2
City State
Zip Code
PRECEPTOR*
Last Name
*
First Name
PRECEPTOR'S CREDENTIALS*
Credentials (i.e. RDN, BS, CDM etc.)
PRECEPTOR'S eMAIL*
example@example.com
PRECEPTOR'S Phone Number*

Area Code Phone Number
Have you received a firm commitment from this preceptor?*

YesNo
Facility will use their own contract. Get this information from your Preceptor.*

YesNoDon't know
Please contact the Preceptor and/or Facility and request that the contract/agreement be sent to:

PNCContracts@Gmail.com
Please describe the type of facility in detail and what you will be doing there.*
ROTATION 2
7/31/23 through 9/8/23
Rotation 2: TYPE OF ROTATION*
Full Legal Name of Facility*
Address*

Street Address
Street Address Line 2
City State
Zip Code
PRECEPTOR*
Last Name
*
First Name
PRECEPTORS CREDENTIALS*
Credentials (i.e. RDN etc.)
Preceptor's Email*
example@example.com
Preceptor's Phone Number*

Area Code Phone Number
Have you received a firm commitment from this preceptor?*

YesNo
Facility will use their own contract*

YesNoDon't know
Please contact the Preceptor and/or Facility and request that the contract/agreement be sent to:

PNCContracts@Gmail.com
Please describe the type of facility in detail and what you will be doing there.*
ROTATION 3
9/11/23 through 10/20/23 IF YOU HAVE PAL credit, this rotation will be 7 weeks.
Rotation 3: TYPE OF ROTATION*
Full Legal Name Name of Facility*
Address*

Street Address
Street Address Line 2
City State
Zip Code
PRECEPTOR*
Last Name
*
First Name
PRECEPTOR'S CREDENTIALS*
Credentials (i.e. RDN etc.)
PRECEPTOR'S Email*
example@example.com
PRECEPTOR'S Phone Number*

Area Code Phone Number
Have you received a firm commitment from this preceptor?*

YesNo
Facility will use their own contract*

YesNoDon't know
Please contact the Preceptor and/or Facility and request that the contract/agreement be sent to:

PNCContracts@Gmail.com
Please describe the type of facility in detail and what you will be doing there.*
ROTATION 4 - 7 WEEKS
10/23/23 through 12/15/23
Rotation 4: TYPE OF ROTATION*
Full Legal Name of Facility*
Address*

Street Address
Street Address Line 2
City State
Zip Code
PRECEPTOR*
Last Name
*
First Name
PRECEPTOR'S CREDENTIALS*
Credentials (i.e. RDN etc.)
PRECEPTOR'S Email*
example@example.com
PRECEPTOR'S Phone Number*

Area Code Phone Number
Have you received a firm commitment from this preceptor?*

YesNo
Please describe the type of facility in detail and what you will be doing there.*
Facility will use their own contract*

YesNoDon't know
Please contact the Preceptor and/or Facility and request that the contract/agreement be sent to:

PNCContracts@Gmail.com
If needed
Do not submit information here without express approval from the Internship Director via email.
Rotation: TYPE OF ROTATION
Starting & Ending Dates
Please explain the reason for adding this Preceptor and Site.
Legal Name of Facility
Address

Street Address
Street Address Line 2
City State
Zip Code
Preceptor Name

First Name Last Name
PRECEPTOR CREDENTIALS
Credentials (i.e. RDN etc.)
Preceptor Email
example@example.com
Phone Number

Area Code Phone Number
Facility will use their own contract

YesNoDon't know
Please contact the Preceptor and/or Facility and request that the contract/agreement be sent to:

PNCContracts@Gmail.com
Please describe the type of facility in detail and what you will be doing there.
NOTES
PLEASE PRINT BEFORE SUBMITTING FORM
Should be Empty:

Please consult Rotation Calendar on PNCDDI.com.

ROTATION 1

ROTATION 2

ROTATION 3

ROTATION 4 - 7 WEEKS

If needed