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EAST TENNESSEE STATE UNIVERSITY College of Clinical and (East Tennessee State University)

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EAST TENNESSEE STATE UNIVERSITY
College of Clinical and Rehabilitative Health Sciences
Department of Rehabilitative Sciences
Nutrition and Foods/Dietetics Program
PO Box 70260 Johnson
City, TN 37614
423-439-7405 423-439-4030 fax
APPLICATION FOR ADMISSION
Application for Fall Semester 20_______
Due to the Department office no later than March
30th
PLEASE PRINT OR TYPE
Date: ____________________________ Expected date of entrance: ___________________________
Student E number: _________________________ Date of Birth: ________________________________
Name: ____________________________________________________________________________________
Last First MI Maiden
Address: __________________________________________________________________________________
Street City State Zip
Cell phone number: ___________________________ ETSU email address: __________________________
EDUCATION HISTORY: Unofficial Transcript (other than ETSU) must be provided with application.
Number of credit hours completed at ETSU: ________________ Transfer hours: _______________________
List the colleges/universities that you are presently attending or have attended in the past, beginning with the
most recent:
Institution Dates Attended GPA Degree Awarded
1.
2.
3.
4.
Complete the following regarding college courses taken or indicate course in progress and where it is being
taken:
Final Grade Institution
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Course
Anatomy & Physiology I/Lab
Anatomy & Physiology II/Lab
Principles of Nutrition
General Chemistry I/Lab
General Chemistry II/Lab
Probability & Statistics
(Next page)
EAST TENNESSEE STATE UNIVERSITY
College of Clinical and Rehabilitative Health Sciences
Department of Rehabilitative Sciences
The dietetics profession requires completion of a 1200 hour supervised practice program (dietetic internship
program) following the undergraduate program in dietetics. Many internship programs are offered at universities
in combination with a graduate program in nutrition, as is the program at ETSU. Admission to dietetic internship
programs is highly competitive and there is no guarantee of acceptance to an internship upon completing the BS
degree.
Students entering health related careers must be of high moral character. A criminal background check is required
of all students admitted to a dietetic internship program following completion of the BS degree program in
dietetics. Prior criminal charges that are directly pertinent to the applicant’s prospective program could affect the
individual’s ability to be allowed in health care settings or to receive a state licensing permit and sit for the national
board examinations. A student with previous criminal charges is advised to consult with the board regarding
licensure/registration eligibility.
For more information, contact the Director of the Undergraduate Program in Dietetics.
I have read and understand the above information.
Signature: ___________________________________________________________
Date: ________________________________
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EAST TENNESSEE STATE UNIVERSITY College of Clinical and (East Tennessee State University)

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Completed 19 January 2021

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