Get State Of Nh Board Of Licensed Dietitians Form 2015-2025

Completing the State Of Nh Board Of Licensed Dietitians Form is a crucial step for those seeking licensure as a dietitian in New Hampshire. This guide will provide you with clear and direct instructions on how to accurately fill out the form online, ensuring a smooth application process.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the section labeled 'Applicant's Name' in the format of last name, first name, and middle name. Include any maiden or other names if applicable.
3. Provide your home address, ensuring to fill out the street, city/town, state, and ZIP code accurately.
4. Input your business address, including the name, street, city/town, state, and ZIP code. This is where you practice or intend to practice as a dietitian.
5. Enter your date of birth in the designated space.
6. Input your email address, ensuring that it is current and accessible.
7. Provide your telephone numbers, both business and home, for contact purposes.
8. Indicate your gender by selecting either M (male) or F (female).
9. Enter your Social Security number as required. Note that this information is mandatory.
10. Answer whether you have ever been a Registered Dietitian by the Commission On Dietetic Registration. If yes, provide your RD number and specify if it was issued before 12/31/00.
11. Detail your educational background, including the highest relevant degree obtained, the year of graduation, your academic major, and the school information.
12. If applicable, provide details about any internship, practice program, or coordinated program you engaged in, including the name, street, city/town/state, and contact information.
13. Carefully read and answer the questions regarding past applications, certifications, or any legal issues. Provide additional explanations as requested.
14. Sign and date the application to affirm that the provided information is accurate and complete.
15. Finally, after completing the form, save your changes and consider downloading or printing the document for your records.

Complete your State Of Nh Board Of Licensed Dietitians Form online today to take the next step in your career.