2017 Wisconsin Act 278, beginning August 1, 2018, prior to submitting an application for a credential, an individual may apply to the Department for a determination of whether the individual would be disqualified from obtaining the credential due to his or her conviction record. To apply for a predetermination, please fill out
Form #3085 and submit all required documentation specified on the form. Pursuant to
Wis. Stat. §
111.335(4)(e), the offenses or kinds of offenses that may result in a refusal, bar, or termination of licensure are published under Additional Resources on the left side of this page.
Pursuant to 2017 Wisconsin Act 319, beginning August 1, 2018, an applicant for an initial credential may apply for a reduction of the initial credential fee that is equal to 10% of the initial fee. Qualification is based on the federal adjusted gross income being at or below 180% of the federal poverty guideline prescribed for the applicant's family household size by the United States Department of Health and Human Services. To determine eligibility please visit the United States Department of Health and Human Services website at https://aspe.hhs.gov/poverty-guidelines, prior to submitting Form 3217.
Wis. Stat. § 440.08 (2), the required renewal date for the Dietitian credential is 10/31/even years. Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.
- An applicant for permanent certification may apply for a temporary certificate at the same time but must pay both fees, have completed education and experience requirements and have submitted an application to take the next available examination.
Pre-Credential Education Information
Received a bachelor's, master's or doctoral degree in human nutrition, nutrition education, food and nutrition, dietetics or food systems management from a program at a regionally accredited college or university located in a state or territory of the United States or from a program that the board determines is substantially equivalent.
Complete at least 900 hours of dietetics practice in any state or territory of the United States under approved supervision. The 900 hours must include a minimum of 300 hours in clinical dietetics, 120 hours in food service administration and 120 hours in community nutrition.
Application for Licensure
2113||Application for Certification to Practice as a Dietitian|
|3217||Application for Fee Reduction (This form must accompany the application for the credential)|
|2128||Dietetics Practicum Experience|
2111||Dietitians Certificate of Professional Education |
2112||Request for a Temporary Dietitian Certificate|
2115||Request for Verification of Registration|
2829||Malpractice Suits or Claims Form (If applicable)|
3085||Application for Predetermination (Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal, state, or local law, including municipal ordinances, in this state or any other)|
2252||Convictions and Pending Charges|
3071||Fax Payment Form|