TARRANT COUNTY COLLEGE SE CAMPUS Dietetics Program Admission Application Packet 2015 2016 An Equal Opportunity Institution/Equal Access to Persons with Disabilities. September 2015
Dietetics Program Degree and Certificates The Dietetics Program offers the following degree and certificates. OPEN ADMISSIONS PROGRAMS (No application required) The following certificates are open admission programs. Students may enroll into any open admissions program without going through an application process. Healthy Meal Planning MSA Award (9 credits) Nutrition Specialist I Certificate (15 credits) Food and Nutrition Coach Certificate (43 Credits) SPECIAL ADMISSIONS PROGRAMS (Application required) Dietetics Special Admissions Programs Application Deadlines: Fall Admission: May 1 st Spring Admission: December 1 st The following certificate and degree are special admissions programs. Students who wish to pursue the degree or certificate must meet the following requirements to apply. Admission Criteria for Certificate in Dietary Manager Have a TCC Student Identification Number Be TSI Compliant Certificate in Dietary Manager is a non-competitive program. All applicants who are TSI compliant and submitted a Dietetics Program Application will be accepted into the Dietary Manager program. Admission Criteria for AAS Degree in Dietetic Technician Have a TCC Student Identification Number Be TSI compliant Complete a minimum of 12 college credits (including the following two prerequisite dietetic courses) by the end of the semester. o FDNS 1103 Introduction to Dietetics (1 Credit Hours) o HECO 1322 Nutrition and Diet Therapy (3 Credit Hours) FDNS 1103 and HECO 1322 must be completed with a B or better within the last five years from the starting semester. Additional 8 college credits must be completed within the last 5 years with a C or better. Applicant Score = Grade Point Average of Dietetics Courses completed within the last five years+ bonus points Bonus points are assigned based on verifiable dietetics work or voluntary experience within last seven years, final grade in Dietetics and Anatomy & Physiology courses within last 5 years, and prior degree completion. Page 1 of 13
Dietetics Program Application Instructions This program application is specifically designed for students applying to the Dietary Manager and/or the Dietetic Technician Program. No application is needed for students interested in enrolling in the certificate programs for Healthy Meal Planning, Nutrition Specialist I, and Food and Nutrition Coach. Please read the Dietetics Application Information Packet carefully prior to completing this application packet. Page 3 Provide your TCC Colleague ID, full name, address, and email addresses. Put your initials on the programs that you are applying for. You may select all of them or only a specific program. Page 4 Provide your name and Colleague ID. Review the content. Print your name, sign and date. Page 5 Please review the Dietary Manager (DM) Program Application Checklist. Read and initial on each line to indicate that you understand the information discussed. Page 6 If you are applying to the Dietetic Technician (DT) Program, please review the Dietetic Technician Program Application Checklist. Read and initial on each line to indicate that you understand the information discussed. Page 7 Describe your career interest and goal in 2-3 paragraphs. Page 8 Provide information on your education history and work experience. DT applicants, please continue on Page 10. Page 10 Provide course and grade information on your prerequisite courses-fdns 1103 and HECO 1322. Provide course information on additional eight credits that you have completed successfully within the last five years. These eight credits may be dietetics or general courses that you have completed at TCC or at other colleges. An official transcript in a sealed envelope is required for each of the institutions listed. Page 11 List all dietetics courses completed at TCC or at other college within the last five years. List Anatomy & Physiology courses completed at TCC or at other college within the last five years. These courses will be used to calculate your Dietetics GPA and bonus points. List highest degree completed. Information provided will be used to calculate your bonus points. Page 12 List all verifiable work and voluntary experience related to Dietetics/Healthcare completed within the last seven years. Information provided will be used to calculate your bonus points. Only experience verifiable by your employers will be awarded bonus points. Page 13 Experience documentation forms are to be completed by each employer listed on page 12. Please put N/A if not applicable. Submit a Dietetics/Healthcare Experience Documentation Form for each employer or agency listed below. Applicants must collect all verification forms and submit them with the rest of the application packet. Send the completed application, official transcripts in sealed envelope and Dietetics/Healthcare Experience Documentation form in one envelope to Tarrant County College-SE Campus, Dietetics Program Admission Committee, 2100 Southeast Parkway, ESEE 2112D, Arlington, TX 76018. All application packets must be postmarked or received by the Division of Business and Technology office by the deadline. Page 2 of 13
Dietetics Special Admissions Programs Application Deadlines: Fall Admission: May 1 st Spring Admission: December 1 st Please print or type the application. Colleague ID (Required): Name: Last First Middle Other (e.g. maiden name) Mailing Address Number and Street City State Zip Country Phone Numbers / / Home Cell Work TCC Email: Alternate Email: Please put your initial on the program that you are applying. I am applying to the Certificate in Dietary Manager Program (20 Credit hours) I am applying to the AAS Degree in Dietetic Technician Program (60 Credit hours) Please select additional certificates that you would like to enroll in. (Courses for these certificates are part of the curriculum for the Dietetic Technician Program. As you complete the program requirements for the Dietetic Technician program, you will also complete the following certificates. No additional application is required.) Healthy Meal Planning (9 Credit hours) Nutrition Specialist I (15 Credit hours) Food and Nutrition Coach (43 Credit hours) Page 3 of 13
Name: Colleague ID: I attest that this application for Admission to the Dietary Manager/Dietetic Technician Program is complete and correct. I understand that by signing and submitting this application I am not guaranteed a place in this program and that I am only eligible for selection according to the terms listed in the information packet. I also understand that by signing the application I am responsible for submitting ALL documents and information required for eligibility into this program to the Dietetics Program. I have read and understand the requirements and procedures for admission into the Dietetics Program as outlined in the Application Information Packet. Student Name (print) Signature Date Page 4 of 13
Dietary Manager Program Application Checklist Name: Colleague ID: *Please read the following carefully and initial all the following items. 1. I have applied to Tarrant County College through a TCC campus registrar, or online at www.tccd.edu/admissions/apply.html. 2. I have read the entire Dietetics Program Selective Admissions Information Packet. 3. I have signed my application (page 3) and will submit the materials before the application deadline to the following address: Tarrant County College-SE Campus Dietetics Program Admission Committee 2100 Southeast Parkway, ESEE 2112D, Arlington, TX 76018 4. I verify that I have met all TSI requirements for Mathematics, Reading and Writing. 5. I acknowledge that I am required to meet Dietetics Program immunization requirements prior to petitioning for practicum. I acknowledge that I will not be allowed to start practicum without meeting these immunization requirements. PLESE NOTE: The Hepatitis B series requires 3 shots over a 6-month period. 6. I acknowledge that I am required to pass a Drug Screening and Criminal Background Check. I also acknowledge that these required checks will be administered within the 30 days prior to my start of the first practicum. If I fail either of these protocols, I acknowledge that I will be dismissed from the program. 7. I acknowledge that I will be required to complete FDNS 1168- Practicum: Dietary Manager during the fall or spring semester on Wednesday and Friday to obtain the minimum 150 hours of supervised practice. 8. I acknowledge that I am able to meet the physical requirements in this program. Inability to meet the physical requirements may affect my practicum placement and performance evaluation. 9. I acknowledge that I am required to obtain CPR for healthcare providers prior to starting practicum rotation. 10. I acknowledge that I have a valid Texas driver license prior to starting practicum rotation. 11. I acknowledge that I have reviewed and understand the policies outlined in the Dietetics Program Student Handbook 2014 version. I agree to abide by all applicable policies of the College and of the Dietary Manager Program. **Applicants are encouraged to contact the Dietary Manager Program prior to the deadline to see if all materials have been received. By signing below, I verify that I have read and understand that I am responsible for providing and meeting the criteria listed in this document. If it is discovered that any of the information I have provided for application has been falsified, I will be immediately dismissed from the program. Student Name (print) Signature Date Page 5 of 13
Dietetic Technician Program Application Checklist Name: Colleague ID: This form is for Dietetic Technician Program s applicant. *Please read the following carefully and initial all the following items. 1. I have applied to Tarrant County College through a TCC campus registrar, or online at www.tccd.edu/admissions/apply.html. 2. I have read the entire Dietetics Program Selective Admissions Information Packet. 3. I have signed my application (page 3) and will submit the materials before the application deadline to the following address: Tarrant County College-SE Campus Dietetics Program Admission Committee 2100 Southeast Parkway, ESEE 2112D, Arlington, TX 76018 4. I verify that I have met all TSI requirements for Mathematics, Reading and Writing.. 5. I verify that I will have completed a minimum of 12 college credits by the end of this semester (and within the last five years) and have enclosed Sealed Official Transcripts from ALL colleges and schools with the application. If you are planning to submit an international (out of the U.S.) transcript, first contact the TCC International Admissions Office at 817-515-5232 to schedule an appointment. Start this process at least eight (8) weeks before the deadline date. 6. I have completed the prerequisite dietetics courses, FDNS 1103 Introduction to Dietetics and HECO 1322 Nutrition and Diet Therapy, with a B better within the last five years; or I am currently enrolled in FDNS 1103 and HECO 1322 with a current B average. (If currently enrolled in these courses, please provide gradebook documentation from your course instructor.) 7. I acknowledge that I am required to meet Dietetics Program immunization requirements prior to petitioning for practicum. I acknowledge that I will not be allowed to start practicum without meeting these immunization requirements. PLESE NOTE: The Hepatitis B series requires 3 shots over a 6-month period. 8. I acknowledge that I am required to pass a Drug Screening and Criminal Background Check. I also acknowledge that these required checks will be administered within the 30 days prior to my start of the first practicum. If I fail either of these protocols, I acknowledge that I will be dismissed from the program. 9. I acknowledge that I will be required to complete three practicum courses over three semesters on Wednesday and Friday to obtain the minimum 450 hours of supervised practice. 10. I acknowledge that I am able to meet the physical requirements in this program. Inability to meet the physical requirements may affect my practicum placement and performance evaluation. 11. I acknowledge that I am required to obtain CPR for healthcare providers prior to starting practicum rotation. 12. I acknowledge that I have a valid Texas Driver license prior to starting practicum rotation. 13. I acknowledge that I have reviewed and understand the policies outlined in the Dietetics Program Student Handbook 2014 version. I agree to abide by all applicable policies of the College and of the Dietary Manager Program. **Applicants are encouraged to contact the Dietetic Technician Program prior to the deadline to see if all materials have been received. By signing below, I verify that I have read and understand that I am responsible for providing, and meeting the criteria listed in this document. If it is discovered that any of the information I have provided for application has been falsified, I will be immediately dismissed from the program. Student Name (print) Signature Date Page 6 of 13
Please describe your career interest and goal in the space provided. Page 7 of 13
Education List the high school from you received your diploma or enter GED/Home School, if applicable. Enter all colleges/universities attended and level of completion. Do not list non-accredited institutions. Check with the Registrar s Office for information on accredited institutions. High School City/State Major Mo/Year & Diploma Awarded High School GPA College or University City/State Major Mo/Year & Degree Awarded Total semester hour Cumulative GPA Work Experience List previous work experience Job Title, Company/City/State Major Duties/Responsibilities Page 8 of 13
** Students applying for the Dietetic Technician Program are required to complete pages 9-11** Page 9 of 13
The following information is required only for Dietetic Technician Program Applicants. Prerequisite Courses Completed Please provide the following information on the prerequisite courses. An official transcript in a sealed envelope is required for each institution listed below. (If currently enrolled in these courses, please provide gradebook documentation from your course instructor.) Course number & title FDNS 1103 Intro to Dietetics College or University Semester and Year completed Credit hours Grade Received or in progress For office use only HECO 1322 Nutrition and Diet Therapy Additional Eight College Credits Completed Please provide the following information for the additional 8 college credits that you completed within the last five years with a C or better. Courses may be dietetics courses (excluding the prerequisite courses listed above) or other general courses. An official transcript in a sealed envelope is required for each institution listed below. (If currently enrolled in these courses, please provide gradebook documentation from your course instructor.) Course number & title College or University Semester and Year completed Credit hours Grade Received For office use only Page 10 of 13
Dietetics / Anatomy&Physiology Courses List all dietetics (nutrition, food management & food preparation) and Anatomy & Physiology courses completed during the last five years at TCC or at other institutions. Please list N/A if none completed. An official transcript in a sealed envelope is required for each institution listed below. Course number & title College or University Semester and Year completed Credit hours Grade Received or in progress For office use only BONUS POINTS CALCULATION (Optional) Please provide the following information to calculate bonus points. What is your highest degree completed? An official transcript in a sealed envelope is required. College or University City/State Major Mo/Year & Degree Awarded For office use only Page 11 of 13
List professional work or voluntary experience related to Dietetics or Healthcare that you completed within last seven years. Only verifiable experience by your employers will be awarded bonus points. Please list N/A if none completed. Attach additional paper if needed. Submit a Dietetics/Healthcare Experience Documentation Form for each employer or agency listed below. Professional Work Experience in Dietetics or Healthcare Job Title, Company/City/State Major Duties/Responsibilities Number of Hours per week Length of employment (years & months) Total hours employed For office use only Voluntary Experience in Dietetics or Healthcare Job Title, Company/City/State Major Duties/Responsibilities Number of Hours per week How many weeks? Total hours For office use only Page 12 of 13
Colleague ID: Student Name: Tarrant County College Dietetics/Healthcare Experience Documentation Form This experience documentation form is optional. It is only required if you would like the Selection Committee to consider your previous work or voluntary experience in dietetics/healthcare field. Documented dietetics/healthcare experience may qualify you for bonus point for admission to the Dietetics program. You do not need to complete this form if you do not want any bonus points for your previous work/voluntary experience. Please complete the top part of this form and give the form to your employer for completion. Please make additional copies of this form if you have more than one employer. Submit one form for each company. Please submit all experience documentation forms with your application. Form submitted separately will not be considered as part of your application packet. The following information must be completed by the applicant s supervisor or company s HR department. Job title of applicant: Company/agency name: Number of hours per week worked/volunteered: Total number of weeks worked in the stated position: Was the position paid or unpaid (volunteer)? Information of person completing this form Print Name Title and Credentials Signature and Date Company Name & Contact Information Page 13 of 13