ALL sections of this form must be completed and all documentation must be received by the College before your application will be processed.

The information requested on this form is collected for evaluating your application for registration. Only your name is made publicly available. For more information about the College’s information and privacy practices, please contact us.

The purpose of these questions is to provide the Registrar and/or Board of Assessors with information about whether an applicant is of good character and will practice dietetics in a safe and ethical manner.

You must answer all questions. If you answer ‘yes’ to any of the questions below, please attach a separate sheet describing the specific situation, dates and the nature of the findings/conclusions. You may be asked to provide additional documentation.

The College of Dietitians of Manitoba requires the following documents:
1. Criminal Record Check with Vulnerable Sector Search
2. Adult Abuse Registry Check
3. Child Abuse Registry Check

Please be aware that only ORIGINAL DOCUMENTS are acceptable for application for registration with the College. If you reside in Winnipeg, you can order your criminal record check ONLINE from the Winnipeg Police Service, you must choose the College of Dietitians of Manitoba as the receiving agency to allow the College to receive the document directly in its official form. Otherwise, the document that is available for you to print out will be stamped with the word "VOID" and is not acceptable to the College. If you don't reside in Winnipeg, please contact your local police service.

Please provide the College with a copy of proof of identity and legal last name (ie. Passport or other photo identification).

NAME CHANGE: If your official transcripts or internship verification are under a different name than the one you are currently using, you must enclose proof of your change in name with this application (e.g. document showing your old name (i.e. birth certificate or marriage certificate) and a government issued ID showing your current name (i.e., driver’s licence, passport)