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Form 4E - Endorsement by an Acceptable Dietitian-Nutritionist (Associate degree applicants only)

Applicants with associate degrees must complete Section I and forward a separate Form 4E to each of the three acceptable dietitians or nutritionists who are endorsing them for certification. Each endorser must complete Section II and submit the form directly to the Office of the Professions at the mailing address at the end of Form 4E.
Electronic Verification of Experience

The Office of the Professions (OP) will accept experience forms directly from supervisors provided that:

  • OP can independently verify that the documentation is received directly from the supervisor
  • The applicant had no opportunity to directly alter the experience form before it is sent or transmitted.
  • Any experience documentation submissions should be made electronically to*.
*Do NOT use this email to submit a question, as we will be unable to provide a response. Submit a Contact Us Form for questions regarding specific applications or to check the status of a licensure application.