Forms & Documents

Landscape image of a beach on the Outer Banks of North Carolina.
Outer Banks, North Carolina.

Forms

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A3: Candidate Form

Category F applicants must complete this Candidate’s Summary Report of the 1,000 hours of documented supervised practice.

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A4: Supervisor Approval

Category F applicants must have each supervisor (named on Form A3) complete the Supervisor Approval Form (A4).

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A5: Supervisor Report

Category F applicants must have each supervisor (named on Form A3) complete the Supervisor Report (A5).

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A6: Coursework

Category F applicants must complete the Coursework Worksheet (A6), documenting qualifying coursework per N.C.G.S. § 90-357.5 (c) (1) (a) and (b) in addition to their Master’s or Doctoral degree.

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A7: Tracking Log (Download)

Documentation of Supervised Practice Hours. Form A7 is an example of the type of information that must be tracked to report hours as they pertain directly to the applicant’s supervised practice experience. Per N.C.G.S. § 90-357.5 (c) (2) and 21 NCAC 17 .0104 (l), applicants must have completed a documented, supervised practice experience in nutrition services of not less than 1000 hours involving at least 200 hours of nutrition assessment, 200 hours of nutrition intervention, education, counseling, or management, and 200 hours of nutrition monitoring or evaluation.

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B2: Supervisor Verification Statement

Category B or G applicants must work under the supervision of a North Carolina licensed LDN or LN, and acquire a signed statement (Form B2) as part of the application process.

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C2: Supplemental Legal Reporting

Applicants answering “yes” to the legal question involving pending criminal charges and/or convictions (and you have not previously reported the action) must complete this form (C2) and provide supplemental documents as requested.

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D1: Doctoral-Level Supervisor Qualification

Supervisors who do not hold a nutrition-specific doctoral degree may complete this D-1 form to seek review under Guideline D, as a Doctoral-level supervisor who meets the academic requirements.

Documents

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Complaint Procedures Document

Important information to review BEFORE filing a complaint.

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Bylaws

These Bylaws serve as the internal operating manual for the NCBDN and provide a framework for how it functions and makes decisions.

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Statute

The Dietetics Practice Act was passed into law in 1991 and serves as the governing authority for regulation of nutrition professionals (dietitians and nutritionists) in North Carolina.

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Rules/Regulations

Regulations, or rules, have the force of law and serve to provide guidelines and procedural language to the statute.

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Code of Ethics

All active licensees of this Board are subject to the Code of Ethics.

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Category F Supplemental Information

Summary of academic and supervised practice requirements required to obtain a license via Category F in North Carolina.

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Guideline A

Details what unlicensed people can/cannot do in the field of nutrition.

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Guideline B

Details standards of practice for licensees in areas of supplements and social media.

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Guideline C

Clarifies the difference in Supervision between an unlicensed person, vs. someone holding an active provisional license.

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Guideline D

Provides Category F & G applicants guidance on how a supervisor may be qualified under the “doctoral-degree” option in N.C.G.S. § 90-357.5(c)(2).

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Use of Third Parties in Licensure Applications

This guideline is intended to establish the NCBDN’s expectations and requirements regarding the use of third parties in the preparation and submission of licensure applications. It ensures that applicants remain personally responsible for the accuracy and integrity of their applications, in accordance with North Carolina General Statute § 90-363.