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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
    • A $50.00 application fee is required. The application fee is non-refundable. 
    • The fee must be paid by check or money order made payable to Utah State University. 

  • Rotation Summary Form: All internship applicants must complete and submit a typed rotation summary form via email. Select ONE form from the options below that describes what type of applicant you are: 
    • Rotation Summary Form — outside of Utah ONLY
    • Rotation Summary Form UT — Utah/Utah-Hybrid/outside of Utah
      • Use this form if you qualify, and are interested in being considered, as a Utah intern, a Utah-Hybrid intern, and/or an outside of Utah intern.

  • 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.
      • Potential preceptors can also send the forms directly to the USU DI at .

Instructions for submitting required forms:

Program Application Fee

The Program Application Fee can be submitted via mail OR submitted via PayPal. 

If submitting via mail

Program Application Fee Form 

  • Complete the Program Application Fee Form
  • Send both the form and the check or money order for $50 to the USU DI. It must be postmarked by February 15, 2021.
    • Pre-select applicants postmark deadline is January 3, 2021.
  • The program application fee form and payment must be mailed to:
    • USU Dietetic Internship (920 W Levoy Drive, Taylorsville, UT 84123)

If submitting via PayPal

Use the form and link below to submit your Program Application Fee. There is a $1.25 service fee to use PayPal. If you pay via PayPal, you do not need to send the Program Application Fee Form. Payment deadlines remain the same. A PayPal account is not required.

Name and Email (required):
DICAS Application Number:

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: first name last name, DICAS #
  • These forms must be sent by the application deadline of February 15, 2021. Pre-select applicant deadline is January 3, 2021.


Step 5: D&D Digital Instructions                Back to Application Instructions