Entry-Level Master of Science in Clinical Nutrition
Supplemental Application

Last Name _______________________First Name ________________________ M.I.______

 Please place an “X” next to the program track you are applying to.

 Program tracks: Local track refers to Rutgers affiliate sites for supervised experiential learning located in New Jersey. Remote track refers to students who will do their supervised experiential learning (rotations) located at sites greater than 100 miles from the Rutgers SHP Newark campus. If your permanent residence is not near one of the remote locations listed, if accepted to the program you will need to agree to temporarily relocate for supervised experiential learning (late March –April through December).  Please select your top 3 choices for relocation site.

 Local __________                              Remote _________              Open to either track ______

 Remote City Ranking: For applicants that have selected the remote track, please rank your top three locations. (One being the top choice number)

Denver, CO                                ____

West Palm Beach, FL             _____

Indianapolis, IN                      _____

Albuquerque, NM                   _____

Las Vegas, NV                          _____

Lebanon, PA                             _____

Wilkes Barre, PA                     _____

Madison, WI                            _____

Applicant Signature: __________________________________________________________