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Step 6: Required Forms

The following forms are required for applicants to the Utah State University Dietetic Internship and without them the applicant's application is considered incomplete. Incomplete applications will not be reviewed. These forms are not to be submitted with the DICAS application.

Required Forms:

  • Program Application Fee Form — updated 8/15/2018
    • The application fee is non-refundable.
  • Rotation Summary Form: All internship applicants must complete and submit a typed rotation summary form. Select ONE form from the options below that describes what type of applicant you are: 
  • All internship applicants will ask their preceptors to complete the following two forms:
    • Facility Form
    • Preceptor Form
      • If you found your preceptor using a preceptor database provided by USU DI and it indicates we already have the forms on file, you do not need to submit the Facility Form or Preceptor Form with your application. 
      • If you are concerned because your preceptor has not returned the forms to you and the application deadline is approaching, please contact the USU DI.

 Instructions for submitting required forms:

Submit via mail:

  • Program Application Fee Form 
    • This form and the check or money order for $50 must be sent through the mail. It must be postmarked by February 15, 2019.
      • Pre-select applicants postmark deadline is Friday, January 4, 2019.
    • The program application fee form and payment must be mailed to:
      • USU Dietetic Internship, USU-SLC, 920 W Levoy Dr, Taylorsville, UT 84123

 Submit via email to the USU DI:

  • Save preceptor forms and facility forms as a PDF and name them as instructed below:
    • File Name:  PreceptorFirstName PreceptorLastName NameOfForm (example: jane smith preceptor form.pdf or ABC Hospital Facility Form.pdf)
  • Save rotation summary form as a PDF and name file as instructed below:
    • File Name: ApplicantFirstName ApplicantLastName NameOfForm (example: jane smith rotation summary form)
  • Please send ONE email with ALL forms attached.
  • Send to:
  • Subject line: last name, first name, DICAS #
  • These forms must be sent by the application deadline of February 15, 2019. Pre-select applicant deadline is Friday, January 4, 2019.


Step 5: D&D Digital Instructions                Back to How to Apply