DATE: ___________________

NAME: ________________________________________________________________

ADDRESS: _____________________________________________________________

CITY: ____________________ STATE: ____________ ZIP CODE: _______

PHONE: __________________ E-MAIL ADDRESS: _______________________

HOMETOWN: _________________________

NAME OF UNIVERSITY YOU ARE CURRENTLY ATTENDING: _______________________________________________________________________

YEAR IN COLLEGE: __ SOPHOMORE __ JUNIOR __ SENIOR

MAJOR: _________________________________________ GPA:____________

ANSWER THE FOLLOWING QUESTIONS. (ATTACH ADDITIONAL SHEETS IF
NECESSARY.)

LIST ANY HONORS OR RECOGNITIONS YOU HAVE RECEIVED.

LIST COMMUNITY ACTIVITIES/ORGANIZATIONS IN WHICH YOU ARE/HAVE BEEN INVOLVED AND POSITIONS YOU HAVE HELD.

LIST YOUR PROFESSIONALS GOALS AND HOW THEY RELATE TO THE PURPOSE OF
THE NORTH DAKOTA NUTRITION COUNCIL. (The purpose of the Council is to improve the
nutritional health of North Dakotans through the promotion of accurate and current nutrition information,
and to support nutrition professionals in their roles as educators and health advocates.)

WHY DO YOU FEEL IT IS IMPORTANT TO BE INVOLVED IN PROFESSIONAL ORGANIZATIONS?

SIGNATURE OF APPLICANT: ___________________________________________

SEND:

COMPLETED APPLICATION
PROOF OF NORTH DAKOTA NUTRITION COUNCIL MEMBERSHIP (COPY OF MEMBERSHIP CARD)
COPY OF TRANSCRIPT
LETTER OF REFERENCE FROM UNIVERSITY PROFESSOR

MUST BE POSTMARKED BY DATE: FEBRUARY 28, 2009.

SEND TO:

FOR MORE INFORMATION, CONTACT: Sandra Rather, LRD, NDNC EDUCATION CHAIR, 430 6th Street North, Breckenridge, MN 56520. Phone: 218-643-0456; sandrarather@yahoo.com