Entry-Level Master of Science in Clinical Nutrition
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)
West Palm Beach, FL _____
Indianapolis, IN _____
Albuquerque, NM _____
Las Vegas, NV _____
Lebanon, PA _____
Wilkes Barre, PA _____
Madison, WI _____
Applicant Signature: __________________________________________________________