Award Application Form

Award Selection*

Recognized Young Dietitian Award*

I confirm that I am 35 years old or younger before April 1, 2025

Name*

First Last

Academy Membership/CDR #*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Status*

FAND?

Indicate type of program*

Name of Institution Attending – Include city and state*

Completed Education, if applicable (if no degree, leave blank)

Highest Degree Earned

Date conferred

Institution – Include city and state

Work Experience, if applicable (list up to 3)

Start date

Title of Position

Organization

City/State

Add another job?

Yes

No

Start date

Title of Position

Organization

City/State

Add another?

Yes

Start date

Title of Position

Organization

City/State

Activities and Honors (list up to 5)

Briefly list achievements including academic honors, student and/or state dietetic association activities, community service activities, other honors

Achievement

Date received

Achievement

Date received

Achievement

Date received

Achievement

Date received

Achievement

Date received

Files must be PDFs only.

All applicants are required to upload your resume or curriculum vitae.

PR Award applicants must also upload supporting documents.

For the ODSA, your one letter of recommendation must be sent directly from your recommender via email and should not be uploaded here. See the Awards Criteria for information on where to send recommendations.

File

Drop files here or

Accepted file types: pdf, Max. file size: 128 MB.

Comments

This field is for validation purposes and should be left unchanged.

Awards Application