Student Interest Form

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Home > Academics > Health and Exercise Sciences > Nutrition and Dietetics > Student Interest Form

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip: *

E-mail:

Phone:

Cell Phone:

I am interested in being contacted with information on classes and workshops related to this program.

I have reviewed the Dietetic Technology Consortium Program Curriculum and I plan on completing the full certificate program.

I am considering completing the Dietetic Technology Consortium Program at PVCC.

The number of classes per term I am interested in taking is:

I am interested in taking summer courses.

I am willing to take a class at another MCCCD college if a class is not available at a time that meets my needs (classes are offered at CGCC, SCC, GCC, and MCC).

My schedule allows me to take: (please enter the number of classes)

day classes:

evening classes:

weekend classes:

on-line classes:

I am interested in courses offered in:

distance learning format (on-line or flex)

traditional classroom format (face-to-face)

I would like to transfer into a 4-year degree program and pursue the Registered Dietitician (R.D.) credential.

Please check other certifications that you would be interested in:

Dietary Managerial Certification

ACSM Health and Fitness Instructor Certification (American College of Sports Medicine)

ACSM Personal Trainer Certification

NASM Personal Trainer Certification (National Academy of Sports Medicine)

NSCA Personal Trainer Certification (National Strength and Conditioning Association)

ACE Personal Trainer Certification (American Council on Exercise)

ACE Group Fitness Instructor Certification

Food Service (e.g. School Nutrition Association (SNA) Certification)

Other Allied Health degree / certifications: (please specify)

Other:

I would be interested in taking additional courses to help me specialize in

Nutrition for Seniors (60+)

Sports Nutrition

Diabetes

Obesity / Weight Management

Lifestyle Coaching

Operating my own business

What past professional or personal experience do you have in the field of health and fitness that has contributed to your interest in this program?:

What is your Education Background:

High School Diploma

College AA/AAS Degree

College BS/BA Degree

College MS/MA Degree

Other Degrees or Certificates

Other Degrees:

Career Opportunities
Continuing Education
Food and Nutrition Course Descriptions
Nutrition and Dietetics
Online Resources
Scholarships

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