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#21-002589-0009
Supplemental Questionnaire

Last Name
First Name

 

**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1

Do you have a bachelor's degree from an accredited college or university?

Yes No

 

If you responded YES to the above question, please upload a copy of your transcript(s) to the application. Unofficial version(s) of the transcript(s) are accepted.


2

Do you possess a license as a Registered Dietitian in the state of Maryland?  If yes, please attach a copy of your license to your application.

Yes No
3

Describe your experience with the following:  the supervision of other employees, overseeing and coordinating the general operations of a unit, applying rules and regulations, or exercising responsibility for the development of policies or procedures.  

Please include name of employer, job title, dates of employment, and hours worked per week.  This information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below. 

4

Describe your experience in the field of food systems management, dietetics, or food and nutrition supervising and overseeing the daily operations of a kitchen or dietary department.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

5

Describe your experience working with patients in a forensics hospital setting.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

6

Describe your experience with creating schedules, submitting and approving timesheets for subordinates.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.

7

Describe your experience with providing medical nutrition therapy to patients in a hospital setting.

Please include name of employer, job title, dates of employment, and hours worked per week, this information must also be reflected in your application.  If you do not possess experience in this area, put N/A in the box below.


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