• PRIORITY NUTRITION CARE DISTANCE DIETETIC INTERNSHIP PRECEPTOR INFORMATION *PLEASE FILL OUT AND SUBMIT ONLINE*
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  • The Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics (AND) defines a "Preceptor" as "a practitioner who serves as faculty for students/interns during supervised practice by overseeing practical experiences, providing one-on-one training, and modeling professional behaviors and values".   THANK YOU IN ADVANCE FOR TAKING YOUR TIME TO HELP A FUTURE DIETITIAN.   THIS FORM MUST BE SUBMITTED IN ORDER FOR THE CURRENT INTERN OR APPLICANT TO BE ABLE TO REPORT THAT YOU ARE ONE OF HIS/HER PRECEPTORS.
     
  • You have been asked to complete this form because a current or potentially future Priority Nutrition Care Distance Dietetic Internship intern has indicated that you are willing to act in the capacity of Preceptor for him or her. One of the requirements of our program is that the interns arrange for their own preceptors, usually close to home. The only way to ascertain whether a Preceptor has agreed to work with an Intern for us to hear it from the Preceptor.   The rotations in which Preceptors are required include Clinical Nutrition, Food Service Management, Community, and an Elective rotation. There could be more than one location/site involved in any of these 4 major areas and/or one individual may precept in more than one rotation type. All preceptors DO NOT have to be Registered Dietitians. However, the student must have RD/RDNs in their Clinical rotations specifically to supervise the Nutrition Care Process and MNT.   An RD who is willing to assist the student in locating different sites and/or experiences and guide the Intern in a situation where a preceptor may be in another profession (s.a. RN, Nurse Practitioner, Social Worker, Psychologist etc.) may be designated as a Primary Preceptor for the Intern and assist them through what can be a daunting challenge in locating other practice sites and learning experiences. The experience and local contacts of the Primary Preceptor would be of great benefit to a student seeking to become a Registered Dietitian. ACEND has recently given DI Programs more latitude in placing students and no longer mandates certain experiences and locations. Instead, we can be more creative in finding ways that Interns can meet the required competencies.
     
  • Please complete the following information:
  • Preceptor's preferred contact information
     
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  • THE FOLLOWING QUESTIONS REFER TO THE LEVEL OF INVOLVMENT YOU ARE WILLING TO HAVE WITH THE APPLICANT AS HIS/HER PRECEPTOR
  • A Primary Preceptor would precept the Intern in one or more areas and use his/her contacts to work with the applicant and the Internship Program to locate appropriate experiences and sites or help the Intern fill in gaps in the supervised practice plan by suggesting contacts.
  • Please note: Clinical Nutrition Rotations (Inpatient facilities are preferred but may be in or out patient in many potential settings,which may include, but is not limited to hospitals, nursing homes, extended care facilities with rehab units, clinics, dialysis centers, radiation therapy departments, private medical offices (must be full time offices) of RD/RDNs, CDEs etc.) Food Service Rotations (May be in Health Care Facilities of any kind, public school systems, colleges & universities, businesses, retail, supermarkets, restaurants.) Community Nutrition Rotations (May be in a public health or community program of any kind, home care, supermarkets,schools, colleges and universities, extension programs,WIC, Meals on Wheels, Elderly congregate dining.) Elective Rotations During the elective rotation,during which the Intern may return to a previous site or go to a new site, the Intern is expected to complete two projects related to the concentration area he/she has chosen, which may be either the Business of Nutrition or The Management of Food and Nutrition Services. These projects may have been started in previous rotations.
  • Please note: Interns may be required to complete experiences at more than one site during one rotation. (example: An Intern is required to be exposed to renal patients but the experience would not comprise an entire 8 week clinical rotation).Certain experiences which may have been viewed in the past as fitting a particular category may now be considered in more than one (ex. MNT may occur in Clinical or Community). Both FS and Community may be completed in public school systems.)
  • THE FOLLOWING QUESTIONS REFER TO THE FACILITY IN WHICH THE INTERN WOULD WORK
  • While a student may locate a Preceptor, the Preceptor must be able to affirm that the administration of the site where the supervised practice will take place will be willing to enter into an affiliation agreement with the Priority Nutrition Care LLC, using the facility's own affiliation agreements/contracts or those of Priority Nutrition Care LLC. These agreements are usually very similar in content.
  • Per accrediting body requirements, affiliation agreements must be signed for any experience in which the Intern will spend more than one week and/or for any experience of any length in which the Intern will be providing direct patient/client care. PNCDDI Affiliation agreements will not be initiated until the Preceptor has agreed to work with the student and THE STUDENT HAS BEEN MATCHED TO THE PROGRAM. PNCDDI is willing to enter into agreements using either their own agreement or that of the host facility. PNCDDI generated agreements may be transmitted and signed electronically.
  • If the facility requires an Internship generated agreement, please fill in the information below which will be included on the affiliation agreement/contract. Please note that is is only a rare instance in which the preceptor would be viewed as a "duly authorized signer" on behalf of an institution or facility, unless the preceptor is the owner or officer of the business.
  • Please complete the following if the information required on the affiliation agreement/contract is different from the name of the local facility (i.e. the local facility is a part of a large company).

  • Regardless of whether you agree to act as a Preceptor for a single rotation, part of a rotation, or a Primary Preceptor who may personally supervise or oversee an Intern who is under the direct supervision of another professional, there are specific requirements that must be met to meet the standards of the Internship's accrediting body (ACEND of AND). The following categories will help us match available experiences to requirements and attempt to help the applicant develop a combination of experiences that will help him/her fulfill the competencies required. Thank you in advance for completing this checklist. It should be noted that some of the learning experiences, which are required of all students, can be fulfilled in several different rotations. Be assured that the Intern will arrive with (and you will receive in advance of the Rotation), a detailed list of learning experiences, which would be typically involved in each Rotation. While these experiences are detailed, they provide enough flexibility for you to be able to assign the Intern activities and projects which should be useful at your facility.
  • There are certain requirements to which all Preceptors must agree in order for the Internship to comply with the accrediting body"s (ACEND) requirements. Please respond to the following:
  • Thank you very very much, on behalf of our program and the applicant, for taking the time to fill out this form.
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  • Please print a copy of this form for your records before submitting.

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