Instructions for Rotation Summary Form
1) Make as many copies as you need of this master form. Keep the “clean” master from the application packet in
case you need it again later.
2) This form is integral to our understanding of your proposed internship experiences. We on the evaluation
committee rely on the information provided in this form to determine if you have organized the depth and breadth
of experiences that are required by CDR for your professional credentials.
3) If the rotation schedule form is not clear and complete, we won’t be able to use it to determine eligibility.
4) A minimum of 300-400 hours must be completed in Clinical, Community and Food Service rotations.
5) A minimum of 200 hours will be completed in the selected concentration area.
6) When scheduling your clinical rotation, please illustrate inpatient and outpatient hours. You must secure a hospital
that offers acute care and a varied experience (e.g., cardiology, oncology, ICU, GI, Diabetes, TPN, eating
disorders, etc, please refer to CRDs). You must have at least one RD as a preceptor for clinical and ideally you
will have more than one RD (e.g., inpatient RD, outpatient RD, etc). All hospitals must be JCAHO approved.
7) A minimum of 40 hours must be included in a Long Term Care (LTC) facility. These hours can be completed in
your clinical rotation or foodservice rotation.
8) Community rotation hours can be completed at one facility or multiple facilities (ex: WIC, Head Start, Senior
Nutrition, Corporate/Employee Wellness, Public Health Departments).
9) When scheduling your food service rotation, please schedule a combination of hospital as well as non-hospital
foodservice hours (ex: schools, non-profit organizations, LTC facilities, institutional facilities).
10) You are required to spend a minimum of 40 hours in a school nutrition program while completing your food
service rotation or Nutrition Education area of concentration.
11) Please follow these instructions to fill out the Rotation Summary Form:
a. Number of Practicum Hours: You must show a total of NOT LESS than 1200 hours in the completed form. It
is acceptable to go over the 1200 hours, but not below. Add up your hours when you have completed the form
and show the total at the end of this column on the last page.
Show the total number of practice hours you will spend at any designated facility. Include ALL facilities at
which you will be gaining experience, regardless of the number of hours you anticipate spending there.
Provide your “best guess” of how many hours it will take to complete the assignments and experiences you
plan to gain at the facility. It’s acceptable to ask your preceptors to assist you in determining how many hours
may be needed for a particular experience. TIP: Even though this column is first on the form, you may want to
complete it last, after you have designated what experiences you will obtain at each site.
b. Facility: Indicate the Full Name (do not use abbreviations) and Address of the facility or site.
c.
Preceptor: Fill in the Name, Phone, and Email for the preceptor that will mentor you in the specific
experiences at this site. If you have multiple preceptors at the same site, use a new row for the individual
Name, Phone, and Email of each preceptor.
d. Rotation Area: Indicate whether the experiences will be Clinical, Foodservice, Community or your
Concentration Area, either Nutrition Education or Management. For Clinical, indicate Inpatient or Outpatient.
Specify individually which experience is for your Long Term Care (LTC) hours, and School Nutrition Program.
For Foodservice, indicate which experience is Hospital and Non-hospital. Be clear about the areas you
indicate and remember to include all required areas listed in the instructions above.
Dietetic Internship
Rotation Summary Form
Name:
Last
First
Middle
Address:
Street
City
State
Zip
Contact Information:
Phone
Options
Check one:
Full-time
NUMBER OF
PRACTICUM
HOURS
Part-time
Email
Concentration Area, check one:
Management
Nutrition Education
FACILITY
PRECEPTOR
Name:
Address:
Name:
Phone:
Email:
City/State/Zip:
Name:
Address:
City/State/Zip:
Name:
Address:
City/State/Zip:
Name:
Address:
City/State/Zip:
Name:
Address:
City/State/Zip:
Name:
Address:
City/State/Zip:
Name:
Address:
City/State/Zip:
Name:
Address:
City/State/Zip:
Total Practicum Hours:
Clinical:
Community:
Foodservice:
Concentration Area:
2/16/2016
Name:
Phone:
Email:
Name:
Phone:
Email:
Name:
Phone:
Email:
Name:
Phone:
Email:
Name:
Phone:
Email:
Name:
Phone:
Email:
Name:
Phone:
Email:
ROTATION AREA