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 WiscMaile-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

Institution / City & State / Date(s) of Attendance / Field of Study / # Credits completed
(as shown on the transcript) / Cumulative GPA
(as shown on the transcript)
UW-Madison / Madison, WI / A / B
C / D
(Attach a separate sheet if you’ve attended 3 institutions) / Overall cumulative GPA, weighted from all institutions* 
*calculation = [(A x B) + (C x D)]/(A+C)]

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
& Year / # Credits / Grade / Grade
points / Comments
Chem 103 and 104; OR
Chem 109 ; OR
AP‡exam score≥ 4
Zoo 101 and 102; OR
Zoo 151
NutriSci 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 application will NOT be reviewed without these transcripts.

Academic Advisor: ___ Approve ___ Reject ___Other, please explain ______

Academic Advisor Signature: ______Date: ______

DPD Program Official Signature: ______Date: ______

(Form revised 11/25/2015)