Graduate Dietitian Application Form

Registration Application	Clear

General Information
ALL sections of this form must be completed and all documentation must be received by the College before your application will be processed The deadline date to submit your complete application is July 24, 2023..

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.
Legal Surname*

Name on your official documents, e.g. birth certificate, passport
Legal Given Name*
Legal Middle Name
Previous Surname(s)
Do you use the legal name given above when you practice dietetics?*
- Yes
- No
If no, provide the name you use when you practice*
Date of Birth*

Day
Month
Year
Home Mailing Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Fax
Preferred Email*

A valid email address is essential. The College uses email to communicate information to members. You also need a valid email address to retrieve your password to your profile account on the College website. In order not to miss out on important emails from the College, we suggest that your email security settings allow mass emails from the College.
Authorization to communicate via email*
- I authorize CDM to forward electronic copies of official correspondence by email.
To speed up the processing of your application, you may authorize CDM to send an electronic copy of your official letters to you by email in PDF format. Originals will be sent in the mail. Because email is not a secure means of communication, the College must have your consent to send official correspondence by email.
Authorization to Work in Canada*
- Canadian Citizen
- Permanent Resident
- Temporary Resident
Temporary Residence - Enclose a copy of your work permit or visa*
Max. file size: 10 MB.

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MPP Program Graduates
If you already registered with the College as a dietetic intern, and you have successfully completed internship, the College would have your official transcripts, criminal, adult and child abuse registry checks and proof of identity. The College requires verification that you have successfully completed a Canadian accredited internship program. A letter will be sent directly to the College from MPP once your final interview is complete.

The following documents must be sent directly to CDM from the University or Institution.
Academic Preparation*
- Official transcripts for each degree sent directly to CDM from the University or notarized copies
- Copy of your degree
Degree/Program Name*
Name of University/Country*
Duration and/or Year of Completion*
Practical Training in Dietetics*
- Official letter sent directly to CDM from a Canadian accredited internship program
Degree/Program Name*
Name of University/Country*
Duration and/or Year of Completion*

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Good Character and Good Conduct
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.
Have you previously registered with CDM?*
- Yes
- No
If yes, please provide your CDM registration number*
Are you or have you ever been licensed/registered with a professional regulatory body (for dietetics or any other profession) in Manitoba, or any other province, territory, state or county?*
- Yes
- No

If yes, please provide details about your registration/licence:*

Name of Regulatory/Licensing Body	Initial Registration Date	Expiry Date of Most Recent Registration

Have you previously written the Canadian Dietetic Registration Examination?*
- Yes
- No

Please include all attempts*

Date	Results

Have you ever been refused for registration with a body that is responsible for the regulation of a professional, either within or outside of Canada?*
- Yes
- No
Do you have any addiction, condition (medical or otherwise) or other circumstance, which compromises your ability to practice dietetics?*
- Yes
- No

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Information of Legal Activity
Have you plead guilty to or been convicted of an offence under the Food and Drug Act (Canada), the Controlled Drugs and Substances Act (Canada), the Criminal Code (Canada), or any other federal or provincial statute?*
- Yes
- No
Have you plead guilty to or been convicted of an offence under any statute of a jurisdiction other than Canada?*
- Yes
- No
Have you been found guilty of professional misconduct or found to have been incompetent or incapable in relation to the practice of dietetics or any profession?*
- Yes
- No
Are you the subject of any current proceedings for professional misconduct, incompetence or incapacity?*
- Yes
- No
Background Checks
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 documents 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.
Original background checks must be received at the College office before we can issue you a GD licence.
- If you require your original background checks returned to you, please check off this box
Proof of Identity
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)

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Graduate Dietitian Licence
A graduate dietitian licence is required to write the next Canadian Dietetic Registration Examination (CDRE). It also allows you to work in the capacity of a dietitian. You may use the title Graduate Dietitian. Upon notification of a pass result of the CDRE, you will be issued a Registered Dietitian licence and may use the title Registered Dietitian (RD).
CDRE Information
Please indicate which exam you would like to write*
- November Exam
- May Exam
I prefer to write in*
- English
- French
Choose the language in which you are more proficient
I will be writing the exam in Manitoba*
- Yes
- No
Do you have any special needs which need to be accomodated?*
- Yes
- No
If you indicate yes, the College will contact you for more details.

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Application Authorization
I certify that the information contained in this application is true and I acknowledge and understand that:*
- If an applicant is found to have made a false or misleading statement or an omission or misrepresentation on their application, any certificate of registration issued to them will be deemed invalid.
- I may not use the title “Graduate Dietitian” until the College has confirmed that I am registered as a member of the College of Dietitians of Manitoba.
- I must notify the College, within 30 days, if there are any changes to the information provided on this form.
- Aggregate exam results will be used for statistical purposes.
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Graduate Dietitian

Graduate Dietitian Application

Step 1 of 7

General Information

MPP Program Graduates

Good Character and Good Conduct

Information of Legal Activity

Background Checks

Proof of Identity

Professional Liability Insurance

Current Employment

Graduate Dietitian Licence

CDRE Information

Application Authorization

Additional information

Graduate Dietitian

Graduate Dietitian Application Form

Graduate Dietitian Application

Step 1 of 7

General Information

MPP Program Graduates

Good Character and Good Conduct

Information of Legal Activity

Background Checks

Proof of Identity

Professional Liability Insurance

Current Employment

Graduate Dietitian Licence

CDRE Information

Application Authorization

Additional information

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