UW-Madison Didactic Program in Dietetics Application
(Please submit completed form to your academic advisor)
I. Contact information
Name - Last
First
Middle
Former
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Campus ID number
WiscMail e-mail Address
Telephone
II. Demographic information (required reporting to the American Dietetic Association)
A. Last 4 digits of the
Social Security Number
___ ___ ___ ___
B. Gender:
___ Male ___ Female
B. Ethnicity:
Are you of Hispanic or Latino origin?
_____ Yes
_____ No
(if yes, choose one or more from the list below)
_____
_____
_____
_____
Cuban
Mexican, Mexican American, or Chicano
Puerto Rican
Other Hispanic or Latino
C. Race: Choose one or more from the list below:
_____ African American or Black
_____ American Indian or Alaskan Native
_____ Native Hawaiian or Other Pacific Islander
_____ Cambodian
_____ Hmong
_____ Laotian
_____ Vietnamese
_____ Other Asian
_____ White
I have applied to the UW-Madison DPD Program in the past (list year/s) ___________________
III. ADMISSION REQUIREMENTS
1. Overall Cumulative GPA ≥ 2.800 (Note: overall cumulative GPA for students entering PDI beginning Fall 2015 ≥ 3.000)
List all institutions of higher education attended (colleges, universities, and technical schools), begin with UW-Madison
Date(s) of
# Credits completed
Cumulative GPA
Institution
City & State
Field of Study
(as
shown
on
the
transcript)
(as shown on the transcript)
Attendance
UW-Madison
Madison, WI
(Attach a separate sheet if you’ve attended > 3
institutions)
A
B
C
D
Overall cumulative GPA, weighted from all institutions*

*calculation = [(A x B) + (C x D)]/(A+C)]
(Form revised 11/25/2015)
III. ADMISSION REQUIREMENTS (cont’d)
2. Mean GPA ≥ 2.800 in the following prerequisite courses (Note: mean GPA for students entering PDI beginning Fall 2015 ≥ 3.000)
Complete the chart below. If you have taken the same course more than once, please note this in the comments column. The highest grade
received will be used to calculate your prerequisite GPA.
Prerequisite
Course(s) you took
(include course Number & Title)
College/
University
Semester
# Credits
& Year
Grade
Grade
points
Comments
Chem 103 and 104; OR
Chem 109 ; OR
AP‡exam score ≥ 4
Zoo 101 and 102; OR
Zoo 151
Nutri Sci 332
Physiology 335
Psychology 202* (or
AP‡exam score ≥ 4); OR
Statistics*; OR
Communication*
‡If AP score is used, exclude this course from GPA calculation
*only ONE of these courses needs to be completed prior to program entry
Total #

credits
Total
grade 
pts
 Pre-req
GPA
I certify that the information in this application is true and complete to the best of my knowledge.
Signature ______________________________________________ Date ___________________
PLEASE ATTACH OFFICIAL TRANSCRIPTS FOR ALL COLLEGES OUTSIDE OF UW-MADISON AND AN UNOFFICIAL COPY OF UW-MADISON
TRANSCRIPT (NOT DARS report). Your
Academic Advisor: ___ Approve
application will NOT be reviewed without these transcripts.
___ Reject
___ Other, please explain ____________________________________________________
Academic Advisor Signature: ________________________________ Date: ___________________
DPD Program Official Signature: ______________________________ Date: ___________________
(Form revised 11/25/2015)