Updated 8-5-14
320 hours of independent field work
Dietetics
FN-397C/E
Student Information
Food and Nutrition Department
University of Wisconsin-Stout
 Demonstrate ability to independently obtain a dietetic position using self-initiative and general guidelines given by the Program Director/Advisor.
 Demonstrate knowledge concerning the field of dietetics which includes the nutrition area and the foodservice area.
 Demonstrate ability to integrate the knowledge from college courses in order to analyze the practice of dietetics as obtained in the field experience. It is recommended that students have the following courses completed: o Community Nutrition o Advanced Nutrition o Nutrition Counseling/Nutrition Assessment o Principles of Management
 Demonstrate a professional attitude, skills, and leadership qualities which are appropriate for a prospective dietitian.
 Attend Field Experience meeting held by the faculty coordinator of dietetic field experience at least two semesters before you plan to enroll.
 Obtain a position or varied positions for a total of 320 hours. The position may be paid or unpaid. Your supervisor must be a Registered Dietitian (RD), however up to 50 hours may be completed under the supervision of someone who is not a Registered Dietitian.
 Complete the field experience application (included in this packet). Develop six outcome objectives related to your position(s) and portfolio. Your outcome objectives should reflect the projects you anticipate to complete.
 Submit your application to the faculty coordinator of dietetic field experience for approval of your field experience. Submit two copies of your learning objectives with your application. You must fill out an application for each experience and all field experiences must be approved by the faculty coordinator.
 Register for FN-397E, after approval of your application. Register for the second credit, FN-397C, at the beginning of the semester when you plan to turn in your portfolio and give your presentation of your portfolio (seminar). Portfolios are due:
Spring: March 5
Please note: you will receive a 10% reduction in points for every week your portfolio is late.
Fall: October 15
**Applications for summer field experience are due by June 15**
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 Attend the Field Experience Meetings .
 The student must submit a copy of the evaluation form and supervisor’s guidelines to the employer at the beginning of the field experience.
Employer must submit evaluation form with hours at the end of the experience. It is the student’s responsibility to see that the form is received by the field experience coordinator; no grade will be assigned until the evaluation form with hours is received.
 Since each of the students will be working in different localities, organizations, and positions, it is the responsibility of the student to obtain the necessary information from the experience to produce a portfolio.
Collect the necessary information to develop portfolio through any or all of the following means: o Interview employer and employees, complete projects with their direction o Observe operations at the worksite and interactions of employees o Read handbooks, handouts, papers, posters, publicity, advertising, policy books, etc. o Listen to what is going on about you o Ask questions
 Develop the portfolio according to the attached outline and instructions.
 Submit the portfolio to the coordinator by the second week of the semester you are registered for your presentation.
 It is the responsibility of the student to register for the second credit of the field experience in the semester in which the presentation will be presented during Advisement Day.
 Field Experience Grade: The portfolio is valued at 200 points and the presentation at 35 points. An
“IP” (In Progress) grade will be submitted at the conclusion of the 320 hours and will be changed to the earned letter grade following the presentation.
 NOTE: Final grade will be awarded when Field Experience Coordinator receives evaluations by the field experience supervisors.
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A formative portfolio will be developed during the field experience. The purpose of the portfolio is to enhance critical thinking, problem solving and communication skills, collaboration, management, research, food and nutrition, nutrition education, counseling, assessment, and therapeutic skills, personal and professional development and provide experiences in health care. The portfolio serves not only as a product of student accomplishment of dietetic program objectives, but also is a continuous evaluation of knowledge and experience acquired. Examples of items to include in the portfolio are listed below.
A completed portfolio will consist of:
1.
Title page, which includes your name and the date and the table of contents
(typed, double-spaced) 10 points
2.
Introduction – Each of the following is included for each site: 25 points a.
Brief history of each organization that field experience hours were obtained b.
Description of the organization i.
Mission/goals/values ii.
Geographical location (this includes a description of the population that is served and the information related to the population of the geographical location) iii.
Size, scope, services offered c.
Brief description of your position(s), including responsibilities, duties, and actual work done at each location
3.
At least ten projects should be included in the portfolio. It is anticipated that eight projects will come from the five remaining areas (see Required Projects, page 3-4); however, the experience may be limited to food service or clinical, thus more than one item may be selected from a single area. Types of projects may be duplicated (i.e., two case studies are acceptable), but this is not recommended in order to facilitate a variety of learning experiences.
4.
A typed project evaluation must be completed for each portfolio project (see page 10), with acceptable grammar and spelling. Each project evaluation includes the following:
140 points a.
Date project completed b.
Describe the requirement fulfilled by this project. For example, if you develop an employee work schedule, this would fulfill the requirement for “Project evident of management skills that reflect current dietetic practice.” c.
Objective(s) of project (e.g., to compose an article for the Senior Edition, or to develop a walk-by display publicizing hunger in Eau Claire) d.
Identify the value and rationale for selecting project e.
Provide a summary of project – several paragraphs that are concise, thoughtful and meaningful. No fluff! f.
Identify how this project demonstrates your skills, strengths and challenges (this means skills and strengths related to personal, education [knowledge] and ability to apply knowledge) g.
Describe what you would change, if anything, about this project h.
Complete a self-assessment (i.e., assign yourself a grade and give statement as to why you deserve that grade. A self-assessment needs to be reflective)
5.
Conclusion a.
Statement indicating how you would use portfolio in the future b.
General analysis of each organization from your point of view
15 points c.
Describe the effect that the experience has had upon your vocational goals including internships, graduate programs and areas of future employment d.
Resumé
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6.
Copies of thank you letter to each site supervisor 10 points
7.
Evaluation of your performance by site supervisor to be mailed to field experience coordinator. Final grade will be awarded when Field Experience Coordinator receives evaluations by the field experience supervisors.
A grade will be assigned according to the point values above
And averaged with the presentation/seminar grade
TOTAL 200 points
100 points
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Projects evident of development and acquisition of competencies for beginning practice in an internship or job.
Required Projects:
1.
Self Reflecting Journal #1 from FSA, clinical, human resources management
2.
Budget Process #2
3.
Choose 8 more projects from each areas # 3 - #8 below. You may choose areas #1 (food service, clinical, human resources) and #2 (budget) again as long as you make sure that you have a good variety of experiences from all of the areas in your experience. The more variety you are able to obtain, the more beneficial this will be for you!
Required:
#1. Self-reflective journal (search online to find information on how to successfully complete a selfreflection. It should be more than just repeating what you did.)
Discuss what you learned and how it relates to your previous knowledge/experience, strengths and areas needing improvement for two areas in food service administration, two clinical areas and two human resource management areas listed below. In your journal entries, discuss the following:
$ For each domain, provide a description of the process you choose (e.g. if you choose to journal about purchasing policies and procedures from food service administration domain, first explain what this process entails, and
$ For each domain, compare (similarities) and contrast (differences) the practice of the organization or site you are working at with the principles you have learned in your college courses or the theory/text book rationale and
$ For each domain, develop a recommendation for improvement or give reasons/rationale why you believe based on your professional judgment why no improvement is necessary. What would you do differently given what you now know based on your experience? Be specific and give rationale for your reasons.
Food Service Administration Domain (choose two) a. Purchasing policies and procedures b. Storage procedures (including receiving, storing and issuing supplies) c. Methods of food production and service (facility layout and time and motion) d. Control systems (menu planning, cost, standardized recipes, food portions, and labor scheduling) e. Safety and sanitation -- policies, procedures, employee training
Clinical Functions (choose two) a. Types of meal plans served b. Procedures for tray assembly and service c. Purposes of therapeutic food plans d. Courses or manner of patient education e. Research in the facility f. Methods used to keep up with new developments g. Relationship of dietitians to other members of the health care team
Human Resource Management Functions (choose two) a. Recruitment of employees b. Selection of employees c. Training of employees d. Evaluation of employees
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Other ideas from this area which can be used for your additional 8 projects:
$ Papers demonstrating critical thinking and clinical decision making (e.g., case study report of a patient or client) (case study of an institutional food management problem and its solution)
$ Given a menu pattern and description of kitchen, evaluate menu cycle. (Provide description of the kitchen, equipment, staff, as well as the menu). Assess the ways in which the US Dietary Guidelines are promoted through the menu above. Identify cultural, production, cost, equipment and other factors that influence menu planning on the above menu.
$ Observe a nutrition counseling session. Consult site supervisor regarding counseling policies and procedures. (Evaluate session using principles learned in nutrition counseling)
Required:
P rojects evident of management skills that reflect current dietetic practice
#2. Budget Process
Through a meeting with the appropriate management or site supervisor, obtain information about the general source of funding for clinical nutrition and budget process of the organization. Review a weekly, monthly and yearly foodservice budget and other tools of financial management utilized.
Give recommendations for improvement; relate role of nutrition management to the budget process.
THE FOLLOWING AREAS ARE INCLUDED FOR YOU TO CHOOSE YOUR REMAINING 8
PROJECTS:
Other ideas from this area which can be used for your additional 8 projects:
$ Evaluate the procedure used for scheduling employees at a foodservice. (Provide a description of the system, plus your evaluation)
$ Do a mock schedule for employees for one week.
$ Develop forms needed by the organization to promote efficiency.
$ Investigate the computer system at the foodservice site and utilize the programs to produce administrative and production related reports.
$ Use a computer program to analyze menus and recipes. (Provide generated reports and analysis)
$ Review the organizational authority and role of nutrition in the organization structure. Include organization authority structure: flow chart, written description of the authority flow; role of the nutrition unit in the organization structure, and description of how nutrition services relates to other departments.
$ Observe nursing home care planning process and relate to previous knowledge, evaluate the process.
$ Plan an employee work schedule. Provide a copy of the schedule and what considerations were made.
$ Synopsis of control systems used -- menu planning, cost, standardized recipes, food portions, and labor scheduling
$ Discuss payment for clinical nutrition services with preceptor.
$ Review job descriptions of nutrition personnel involved in food service, clinical care or community programs. Write a job description for an employee (i.e., cafeteria worker, etc.)
$ Review the facility's quality improvement plan, if no plan make a plan for some aspect of services.
$ Develop a form(s) needed by organization to promote efficiency.
$ Conduct a sales analysis.
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Ideas from this area which can be used for your additional 8 projects:
#3. Projects evident of communication skills and participation in community services, applied research and education programs to improve well-being of people throughout life cycle.
$ Describe, video or audiotape documentation of interviews or student-client interaction, presentation.
Include a description of the session, client, etc., and evaluation of the session if available. Be sure to obtain written permission before videotaping any client or group.
$ Describe the nutrition education functions: nutrition education goals of the organization, target audiences, activities, critical evaluation of success and special problems. If organization has no program, design what you feel would be a successful program for the organization.
$ Prepare sample of writing for specific audiences (children, teen, aged, ethnic groups) on a nutrition topic. Include a description of the target audience, a description of the type of publication, objectives for the written material and any outside evaluation of the written work if available. (e.g., newsletter articles, press releases, brochures)
$ Oral presentations (e.g., health promotion, inservice for dietary department)
$ A lesson plan or series of lesson plans for a group nutrition education class. Include a description of the group including age, number of participants, education level and any other pertinent characteristics. Lesson plan must include objectives, specific content outline, plan for evaluation of objectives, and audio visual aids or handouts used. If lesson was given include evaluation of participants learning.
$ Examples of education materials developed, reflection of how analysis of target group affected development. Include your evaluation of materials or evaluation by preceptor or the target group.
$ Documentation of prior class work to the current experience in community.
$ Participation and self-reflection of the value of an activity (e.g., health fairs, nutrition education classes, patient counseling/instruction, personal goal setting)
$ Plan, coordinate and provide nutrition education in a wellness setting
$ Determine types of resource materials utilized to provide nutrition care
$ Participate in two of the following programs a. home delivery of meals b. congregate meal site for the elderly c. WIC program d. food bank e. food stamp program f. National School Lunch Program g. School Breakfast Program h. Summer Foodservice Program for Children
$ Produce a list of food, nutrition and social service resources available in the area. Include name of program, contact information and services provided.
$ Cooperate with Dairy Council to conduct nutrition education in schools.
$ Cooperate with Head Start to provide education program for parents or children to integrate math or social studies with nutrition
$ Research funding of 2 community nutrition programs and document how funding is generated
$ Attend a city, county or state hearing where an issue related to nutrition or health is being discussed.
$ Participate in collection of data on nutrition care in a community program and discuss purpose of data with preceptor.
$ Write state or federal legislator about a nutrition issue.
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Ideas from this area which can be used for your additional 8 projects:
#4. Projects documenting understanding of the implications of physiological, cultural and social factors affecting use of food.
$ Develop or test a recipe for a foodservice operation and evaluate it in terms of sensory appeal and suitability of the recipe to the facility. (Provide recipe and your evaluation. Provide consumer evaluation data if available)
$ Documentation (written or video) of working with diverse populations (e.g., working with Hmong clients at a WIC site)
$ Community involvement (e.g., health fairs, community outreach). Include a description of the involvement and any evaluation if available.
$ Health promotion activity, sports team, improvement of cafeteria service, bulletin board.
$ Assess customer satisfaction with the food served. (Provide the survey you prepared and the results of the survey. Survey needs to have at least 10 questions.)
$ Interview residents to determine satisfaction.
$ Conduct a plate waste study.
$ Assess the "menu products" and marketing strategies of a foodservice system to determine if the operation is adequately meeting the needs of the target population.
$ Interview residents to determine satisfaction.
$ Conduct a plate waste study.
$ Assess the "menu products" and marketing strategies of a foodservice system to determine if the operation is adequately meeting the needs of the target population.
Ideas from this area which can be used for your additional 8 projects:
#5. Projects evident of development of skills in planning and application of diets modified for therapeutic purposes and to prevent disease.
$ Write a description of proficiency verifications (e.g., interpretation of lab values for a case study on a patient).
$ Transcription of therapeutic conversations (e.g., discussion with other team members-physician, nurse, speech therapist, other dietitian regarding patient care, discharge planning, nutrition rounds)
$ Nutrition screens/assessments and documentation of nutrition care plans
$ Determine nutrient and energy requirements based on assessment data (i.e., anthropometric, biochemical, clinical, etc.)
$ Case study of drug-nutrient metabolism, investigation of drug-nutrient interaction of patients.
$ Documentation of measuring and interpreting body composition data
$ Examples of therapeutic diets used for common conditions, examples of patients with medical problems and diets used. Include charting and nutrition intervention completed on each patient, do not use the patient's real name. Some choices of diagnoses and age groups include: Type I diabetes mellitus, type II diabetes mellitus, GI disease, cancer, renal disease, cardiovascular disease, liver or pancreatic dysfunction, enteral nutrition support, parenteral nutrition support, obstetric patient, surgery, oncology.
$ Calculations of enteral and parenteral formulations. Research types of formulations that are available in facility and from different suppliers.
$ Write a summary of computer resources in a clinical or community or food service setting.
Procedures utilizing the computer resources.
$ Describe and demonstrate blood glucose monitoring.
$ Demonstrate technique for determining hematocrit.
$ Evaluation and description of nutrition education materials used with inpatient/outpatient and evaluation strategy used.
$ Develop nutrition education materials.
$ Description of the requirements for a soft, sodium restricted and calculated diet. What types of meal plans are provided? What are procedures for tray assembly and service?
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$ Determine types of resource materials utilized to provide nutrition care.
$ Document patient assessment and nutrition care in a long-term care unit.
$ Types of snacks and supplement foods utilized. Conduct research on supplemental foods available.
Ideas from this area which can be used for your additional 8 projects:
#6. Projects evident of enhancement of skills to selection, purchase, storage, preparation and service of food.
$ Make a purchasing decision about a product, based on food and labor costs, intended use, preparation and storage requirements and sensory evaluation. (Provide written documentation on the above including a purchase specification.)
$ Evaluation of storage procedures of a food service facility (receiving, storing and issuing). If needed, help organize storage areas including dry storage, freezer, and refrigerator.
$ Conduct inventory of food, paper supplies and food service ware.
$ Help develop a menu for holiday, special event, catering function or school lunch and participate as much as possible in all aspects of the production, recipe development, purchasing, forecasting, scheduling, projection and service. (Provide menu, description of the event, description of projection etc., in which you were directly involved).
$ Interview food service director about cost control techniques utilized. Accurately prepare a cost comparison (Food and labor costs) of products for use in a foodservice operation and make recommendations for purchasing based upon these findings.
$ Complete Quality Improvement project on an aspect of food service (e.g., dietary snack passing).
$ Identify local, state and federal regulations that impact food procurement, production, distribution and service.
$ Review department = s policies and procedures with respect to food procurement (selection and purchase), production, distribution and service. Write specification for food item. Conduct inventory of food service ware.
$ Rotate through all foodservice positions providing A staff relief @ as appropriate. Write job description of the positions.
Ideas from this area which can be used for your additional 8 projects:
#7. Projects evident of skill building in the management of the physical facility including staffing, quality control, sanitation, merchandising, and use of equipment.
$ Review an employee evaluation or rating form. When are employees evaluated; what is procedure for an individual who is not performing well on the job? Develop an employee rating form.
$ Describe marketing plan and marketing activities of the organization (food service or outreach services). Develop a marketing project.
$ Accurately assess the state of sanitation at a foodservice facility through inspection, problem identification and recommendation of solutions. (Provide copy of checklists completed and a copy of your report.)
$ Evaluate kitchen safety in the facility. (Provide your checklist as well as a summary of your findings.)
$ Write an equipment proposal. (Provide the original proposal plus a description of the effectiveness of the equipment if subsequently purchased.)
$ Write procedures for operating and cleaning 2 mechanical equipment items.
$ Discuss employee turnover, employee productivity, and job satisfaction with site supervisor. Make a plan for improvement if needed.
$ Plan, implement, and evaluate inservice training for staff.
$ Examine the JCAHO regulations regarding food safety in the nursing home or hospital and compare to food safety in a cafeteria setting.
$ Develop HACCP plan for two menu items; include critical control points throughout the recipe.
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$ Develop a risk analysis plan for the foodservice operation for three of the following: food temperature, inventory systems, storage, employee conflicts, employee injuries, customer injuries, sexual harassment, schedule conflicts, smoking, alcohol, cleanliness, equipment, improper portions, language barriers, foreign objects in food.
$ Develop a training plan for a new employee for new employee as well as evaluation after training for a particular job.
Ideas from this area which can be used for your additional 8 projects:
#8. Projects providing evidence of development of personal and professional attitudes and values, leadership skills, ethics and decision-making skills necessary for a dietetic practitioner.
$ Attend a city, county or state hearing where an issue related to nutrition or health is being discussed.
$ Documentation of professional responsibility through faculty, peer, supervisor/employer evaluation.
$ Attend inter/intra departmental meetings as permitted. Describe the process and what leadership styles were evident. What decisions were made? What ethical values were demonstrated?
$ Document the dietitian = s interaction with 2 other healthcare professionals in clinical and community settings. Discuss points of communication for developing professional interpersonal relationships.
$ Research the stance of an elected official related to nutrition related issues.
$ Write a state or federal legislator about a nutrition issue.
$ Attend in-services, seminars, continuing education, and local, state, regional, and national dietetic meetings.
$ Participate in medical nutrition support rounds.
$ What are procedures to insure confidentiality is maintained? Give examples where confidentiality was maintained. (Do not give individual patient or client = s name.)
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Each project in your portfolio must include the following information (typed).
1.
Title “Project Evaluation Sheet”
Your Name ___________________________ and date project completed ______________________
2.
Describe the requirement fulfilled by this project. For example, if you develop an employee work schedule, this would fulfill the requirement for “Project evident of management skills that reflect current dietetic practice.”
3.
Discuss objective(s) or project (e.g., to compose an article for the Senior Edition, or to develop a walk-by display publicizing hunger in the Eau Claire area)
4.
Write a statement identifying the value and rationale for selecting project.
5.
Give general summary of the project.
6.
Write a statement identifying how this portfolio project demonstrates your skills, both strengths and challenges.
7.
Describe what you would change, if anything, about this project.
8.
Prepare self-assessment (i.e., assign yourself a grade and give a statement as to why you deserved that assigned grade).
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Section
Point Value
10
25
14
14
14
14
14
14
14
14
14
14
15
5
5
200
Portfolio
Point Value
Student Name ____________________________________
Work Experience Address: __________________________
Format acceptable – includes title page, table of contents, typed (double spaced), follows outline, acceptable grammar and spelling
Introduction – each item is included.
Brief history of organizations where field experience obtained
Description of the organizations
-Mission/goals/values
-Geographical location (this includes a description of the
population that is served and the information related to the
population of the geographical location)
-Size, scope, services offered
Brief description of your position(s), including responsibilities, duties, and actual work done
Required Project – Self-Reflective Journaling
Six functions described (two functions from each of 3 areas)
Food Service; Clinical; and Human Resource Management
All functions compared and contrasted to classes.
Recommendations made for all items.
Project Evaluation Sheet
Required Project – Financial Management
Appropriate information given
Role of nutrition
Recommendations for improvements are included
Project Evaluation Sheet
Eight portfolio projects with eight project evaluation sheets
Project #1
200
Project #2
Project #3
Project #4
Project #5
Project #6
Project #7
Project #8
Conclusion
Statement of how you would use portfolio
General analysis given of each organization (opportunities presented to you for Field Experience and the work and value of the RD provides within the organization)
Description of vocational goals given
Resumé
Copies of thank you letters
Copy of DARS Report or course history
Rating for Portfolio
Total points available
Total point value of portfolio
Letter grade
A = 94–100%
A- = 91–93%
B = 84-87%
B- = 81-83%
B+ = 88–90% C+ = 78–89.9%
C = 71-73.9%
C- = 71-73.9%
D = 60-70.9%
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Field Experience Seminar Evaluation – 35 points
Introduction:
Gains the attention of the audience
Summary:
Most important and most interesting points, see below (10 points)
(5 points) _____________________
_____________________
Conclusion: (What you would do differently/Tips)
_____________________
Non-verbal and verbal expression:
Appearance, volume, pace, enunciation, inflection (5 points)
(5 points) Informal Discussion:
Length:
Portfolio Points _______
Seminar Points _______
(5 points)
(5 points)
_____________________
_____________________
_____________________
Total _______
Final Grade _______
PRESENTATION: Planned for Advisement Day the semester you complete your portfolio
Length:
Portfolio review:
1.
2.
3.
4.
3 to 5 minute presentation within a panel setting.
Brief highlight of field experience sites and type of experiences
Most interesting Project (s)
What you would do different
Tips for future students
Informal Discussion: Audience will ask questions of panel, all presenters welcome to respond to questions.
Name _____________________________________
Date _______________________________
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Dietetics
Site Supervisor Information
Department of Food & Nutrition
University of Wisconsin-Stout
This is a general guideline for supervisors of Field Experience students. Field experience is a course designed to allow students to apply the theories from the classroom in real situations. This benefits students in many ways. Those that have completed the majority of their coursework have more knowledge to apply, but those with less classroom experience gain in that they return to their courses with greater enthusiasm, knowing that the information is needed in actual situations.
Ideally, students will receive exposure to several foodservice clinical and nutrition evaluation functions, so one facility may not be able to offer all three areas. In this case, students may complete their 320 hours of field experience at more than one location. Students are required to turn in a completed portfolio of their experiences and projects completed at your site.
Food Service Administration Domain (choose two) a. Purchasing policies and procedures b. Storage procedures (including receiving, storing and issuing supplies) c. Methods of food production and service (facility layout and time and motion) d. Control systems (menu planning, cost, standardized recipes, food portions, and labor scheduling) e. Safety and sanitation -- policies, procedures, employee training
Clinical Functions (choose two) a. Types of meal plans served b. Procedures for tray assembly and service c. Purposes of therapeutic food plans d. Courses or manner of patient education e. Research in the facility f. Methods used to keep up with new developments g. Relationship of dietitians to other members of the health care team
Human Resource Management Functions (choose two) a. Recruitment of employees b. Selection of employees c. Training of employees d. Evaluation of employees
Attached is a copy of the student evaluation form for your reference. You will receive one from your student, or may use another type of assessment if you prefer. Please record hours worked. Upon completing the evaluation form, please return to:
Karen Ostenso, PhD, RD, CD
Field Experience Coordinator
University of Wisconsin-Stout
225 Heritage Hall
Menomonie, WI 54751
If you have any questions or concerns, please call Karen Ostenso, PhD, RD, CD, Field Experience Coordinator, at 715-232-2394.
Without your assistance, this valuable part of students’ education would not be possible.
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Total number of hours worked at site: __________ Name: ________________________________
Please rate the applicant on the qualities you feel you can judge on the grid below. Indicate your perception of the student’s readiness to function in a dietetic internship program at this time. Provide comments of ratings and your signature on next page.
Student’s Name
O MS
Actual or Expected
Date of Graduation
SAT NI U
O–Outstanding; MS-More than Satisfactory; SAT–Satisfactory; NI-Needs Improvement, U-Unsatisfactory
Unable to
Evaluate
Application of Knowledge
Nutrition Content
Medical Nutrition Therapy
Foodservice Management
Analytical Skills/Problem Solving
Conceptual Skills
Communication Skills
Oral
Written
Interpersonal Skills
Peers/Co-Workers
Teachers/Supervisors
Leadership Potential
Initiative/Motivation
Punctuality
Adaptability
Reaction to Stress
Perseverance
Creativity
Organizational Skills
Works Independently
Responsibility/Maturity
Overall Potential as a Dietitian
Relationship to Applicant:
If Other, please indicate relationship:
How long have you known applicant?
Advisor: Teacher: Work Supervisor: Other:
How well do you know applicant?
Do You:
(Check appropriate box.)
Highly
Recommend
5 4
Recommend
3 2
Not
Recommend
1
Prepared by The American Dietetic Association and Dietetic Educators of Practitioners Practice Group for optional use by dietetics education programs (2004).
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Additional Information: Use to amplify or add to characteristics rated on previous page. Indicate applicant's strengths and those qualities that require further development. (May use a separate sheet or letter.)
Strengths :
Qualities that Require Further Development :
Name
Signature
Position
Place of employment
Address
Phone
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E-mail
Date