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WA Academy - Outstanding Dietitian of the Year Award Application

1.

Please complete the application completely.

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* 1. Submitted by:

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* 2. Please enter the ODY candidate information:

Name: *

Company:

Address: *

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

Country: *

Email Address: *

Phone Number: *

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* 3. Is the candidate a current Washington State Academy member?

Yes

No

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* 4. Candidate's Academy membership number:

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* 5. Candidate has been an active national Academy member for a minimum of 8 years.

Yes

No

Unknown

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* 6. Please upload the candidate's CV here.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 7. ODY candidates must be 35 years or older as of 1/31/2025.

Please enter the candidate's birth date.

Date

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* 8. Please enter the education information.

Highest degree completed

Date of highest degree

Institution

City/State