UAND Awards
Award Category
Outstanding Dietitian of the Year
Recognized Young Dietitian of the Year
Emerging Dietetic Leader
Outstanding Dietetics Student
Name
First Name
Middle Initial
Last Name
Credentials
(as they should appear on the award)
Academy Membership Number
Date of Birth
-
Month
-
Day
Year
Date
Preferred Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Education
(Info from nominee data sheet if not included on resume)
Work Experience
(Info from nominee data sheet if not included on resume)
Demonstrated Leadership or Contribution to Dietetics
(Info from nominee data sheet if not included on resume)
Student's Current Educational Program
Institution
City, State
Dietetics Education Program Type
Coordinated Program
Dietetic Internship
Didactic Program in Dietetics
Dietetic Technician
Activities and Honors
Briefly list achievements including: honors (academic and other), student dietetic association activities, community service activities, etc.
Activities, Honors and/or Organizations
(include approximate dates)
Nominating Individual (person filling out this form)
Self-nomination
Nominating someone other than self (contact info below)
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Upload Nomination Letter and Resume
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