CNC (California Nutrition Corp) Application

CNC (California Nutrition Corp) Application

Complete applications with all attachments must be submitted by 5:00pm on January 17, 2025. Scores are given based on essay, financial need, ethnicity, and WIC years of service. Awards will be based on scores and advisory committee recommendations. After your submission, your application will be automatically emailed to your WIC Director for approval (at their email you enter). Please contact Lena Workman at lworkman@calwic.org with any questions.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Language of Origin (other than English)
Languages Spoken (other than English)/Your Fluency
Your Fluency In Other Language

1

2

3

4

5

1 is Basic, 5 is Fluent
Ethnic Background*

African AmericanAsian/Pacific IslanderCaucasianLatinxNative AmericanOther
Employment & Program Information
Name of WIC Agency Employer (Choose one)*
Your WIC Director Email (an email will be automatically sent to this address to approve your application)*
name@agency.org
Hire Date At WIC*

MonthDayYear
Date
Full Time or Part Time (choose one)*

Full TimePart Time
If Part Time, average number of hours per month at WIC
Permanent or Temporary Position (choose one)*

PermanentTemporary
Have you ever applied for a CNC Scholarship under any other name? If yes, please enter the name
Choose what program you are enrolled in*

WIC Dietetic InternshipOther Dietetic InternshipGraduate SchoolUndergraduate School (Dietetics, Nutrition, Other Related Major)
If Other Dietetic Internship, please list program
If Graduate or Undergraduate School, enter field of study
Start date of your program*

MonthDayYear
Date
Expected completion date of your program*

MonthDayYear
Date
Upload Essay, Recommendations, and Financial Statements
Essay 500-1000 words entitled "My Professional Nutrition/WIC Career Goals" (cut and paste from a document)*
Financial Needs Statement (one to two paragraphs)*
Upload Financial Budget Worksheet*

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Upload Completed Recommendation from WIC Program Employer*

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Upload Completed Recommendation Form from University or Dietetic Internship*

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Upload Verification of enrollment in your program (e.g. current class schedule, acceptance letter into DI program)*

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Upload Picture*

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Signature*

Clear
I hereby certify that all the information provided in this application is true and correct.
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CNC (California Nutrition Corp) Application

Employment & Program Information

Upload Essay, Recommendations, and Financial Statements