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SDA Application Form

The information requested on this form will be used for the purposes of determining eligibility to be registered and licensed with SDA, administration of the Canadian Dietetic Registration Exam and generally for carrying out SDA’s regulatory mandate under the Dietitians Act. This information will be maintained in a database and the names of actively licensed members will appear in a register availably publically on the SDA website. SDA will provide information to eHealth Saskatchewan for their provider registry system to enable Dietitians to be authorized for access to the electronic health record viewer. Data will be provided in aggregate form only to outside agencies (e.g. Canadian Institute for Health Information, Saskatchewan Health) for the purposes of workforce planning. If you have questions about the information being requested or how it will be used, please contact the Registrar at (306) 359-3040 or via email at registrar@saskdietitians.org.

* The following fields are required

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A: General Information
Note: Your listed surname may be changed only by special request. Please email the following address to submit such a request: registrar@saskdietitians.org
Surname*
Prev. Surname
Given Name(s)*
*
- Dr.
- Ms.
- Miss
- Mrs.
- Mr.
- Mx.
Birthday*
Gender*
Age Group*
Please type the name you wish to have appear on your licence:*
My prefered place to receive email from SDA is:*
- Home
- Work

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B: Home Address
*
Street Address City State / Province / Region ZIP / Postal Code Country
Email*
Phone*

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C: Dietetic and Related Employment
Please provide details for all dietetic and related employment. Click on the dropdown menu labelled “Number of employers” and select the appropriate number of employers that you have. This will open up the appropriate number of fields (ie. select 2 if you have 2 employers or 2 different jobs within same employer). The information you provide in regard to status (full time, part time, casual), area of practice and location of practice may be used in aggregate form for workforce planning and to monitor trends
Number of employers:
First Employer
Position/Title
Organization
Start Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Email
Phone
Status
Area of Practice
Other Area of Practice:
Location of Practice
Age Groups
Geographic Service Area
Identify geographically the where you work in Saskatchewan. This information will be used in the find a member feature on the members only side of the SDA website. If you provide services throughout the entire province, select provincial. If you do not live/work in Saskatchewan, select Not Applicable.
Second Employer
Position/Title
Second Employer Organization
Start Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Email
Second Employer Phone
Status
Area of Practice
Other Area of Practice:
Location of Practice
Age Groups
Geographic Service Area
Identify geographically the where you work in Saskatchewan. This information will be used in the find a member feature on the members only side of the SDA website. If you provide services throughout the entire province, select provincial. If you do not live/work in Saskatchewan, select Not Applicable.
Third Employer
Position/Title
Organization
Start Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Email
Phone
Status
Area of Practice
Other Area of Practice:
Location of Practice
Age Groups
Geographic Service Area
Identify geographically the where you work in Saskatchewan. This information will be used in the find a member feature on the members only side of the SDA website. If you provide services throughout the entire province, select provincial. If you do not live/work in Saskatchewan, select Not Applicable.
Fourth Employer
Position/Title
Organization
Start Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Email
Phone
Status
Area of Practice
Other Area of Practice:
Location of Practice
Age Groups
Geographic Service Area
Identify geographically the where you work in Saskatchewan. This information will be used in the find a member feature on the members only side of the SDA website. If you provide services throughout the entire province, select provincial. If you do not live/work in Saskatchewan, select Not Applicable.
Fifth Employer
Position/Title
Fifth Employer Organization
Start Date
Date Format: MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Email
Phone
Status
Area of Practice
Other Area of Practice:
Location of Practice
Age Groups
Geographic Service Area
Identify geographically the where you work in Saskatchewan. This information will be used in the find a member feature on the members only side of the SDA website. If you provide services throughout the entire province, select provincial. If you do not live/work in Saskatchewan, select Not Applicable.

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D: Academic Training
Official transcripts must be sent directly to SDA at 17-2010 7th Ave. Regina, SK S4R 1C2 from the university where you completed your dietetic education or the Canadian dietetic regulatory body with whom you are currently licensed. If you were accepted into a nutrition program based on transfer credits from another university, you will need to have transcripts sent from that institution as well.
Food and Nutrition Degree*
University*
Year Granted*
Other Degree
University
Year Granted
Other Degree
University
Year Granted

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E: Practical Training/Internship
Confirmation of completion of practical training must be sent directly to SDA at 17-2010 7th Ave. Regina, SK S4R 1C2 from program coordinator or the Canadian dietetic regulatory body with whom you are currently licensed.
Program Name/Location*
Year of Completion*
Program Director*

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F: Additional Certifications
Indicate any relevant certifications you have received as well as initial date of certification and any recertifications since that time (ie. CDE, CNSC, Wellness Coach, etc)
Certification
Year of completion
Recertification Date(if applicable)
Date Format: MM slash DD slash YYYY
Certification
Year of completion
Recertification Date(if applicable)
Date Format: MM slash DD slash YYYY

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G: License & Registration
SDA has three types of licences: Full practising, temporary and restricted:
- If you are transferring from another Canadian dietetic regulatory body, apply for a full practising licence.
- If you are licensed in another jurisdiction in Canada and only need to be licensed in Saskatchewan on a short term (less than 3 month) basis, apply for a temporary licence.
- If this is your initial registration with a regulatory body and you have not yet written and passed the CDRE, you will be applying for a restricted licence.
If you have questions as to what type of licence you are applying for, contact the Registrar at registrar@saskdietitians.org
Type of Licence*
- Full Practicing Licence
- Temporary Licence
- Restricted Licence

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H: Canadian Dietetic Registration Exam
Have you previously written the CDRE registration examination?*
- Yes
- No
If so, please provide the following information:
Result*
Date of Examination*
Date Format: MM slash DD slash YYYY
If you are doing your initial registration and are applying for a restricted licence with SDA, please provide the following information and submit payment for the exam fee and you will be pre-registered to write the Canadian Dietetic Registration Exam (CDRE) at the next available examination session.
Select the language you prefer exam communications in:
- English
- French
Will you require an exam accommodation?
- Yes
- No
If yes, please provide details and/or contact the SDA office to provide details.

Once SDA has approved your restricted licence, you will be provided with information on scheduling your exam writing at a Pearson Vue exam center. Candidates may choose to write at any testing center anywhere in Canada. Seats for the CDRE are on a first come first serve basis, therefore you are encouraged to register with SDA and schedule the CDRE as soon as is possible to ensure that a seat is available.
Please indicate whether you plan on writing the exam in Saskatchewan:
- Yes
- No
If no, please identify the province you plan on writing the exam in:
Your contact information will be shared with the exam testing agency Yardstick Assessment Strategies Inc. and the exam writing agency Pearson Vue. This information will be collected, used and disclosed according to their privacy policies and will be subject to U. S. laws, including the USA Patriot Act.

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I: Good Standing & Professional Conduct
In addition to answering the following questions on good standing and professional conduct, an original, current (within six months) criminal record check must to be mailed directly to SDA at 17-2010 7th Ave. Regina, SK S4R 1C2 or sent directly to the Registrar if done through an online service (eg. www.mybackcheck.com). If you have questions regarding what is required for the criminal record check, contact the Registrar.
1. Have you ever been found guilty of a criminal offence or an offence under the Food and Drug Act or Narcotic Control Act?*
- Yes
- No
2. Have you ever been found guilty of professional misconduct and/or incompetence in Saskatchewan or any other jurisdiction in relation to the practice of dietetics or any other profession?*
- Yes
- No
3. To your knowledge, are you currently being investigated for professional misconduct and/or incompetence in Saskatchewan or any other province, territory, state or country?*
- Yes
- No
4. Have any findings of professional negligence ever been made against you in a civil or criminal proceeding within or outside Canada?*
- Yes
- No
5. Have you ever been refused for registration with a body that is responsible for the regulation of a profession either within or outside of Canada?*
- Yes
- No
If you have answered "yes" to ANY OF THE ABOVE QUESTIONS, please provide details*
6. Are you presently registered in any other jurisdiction related to the practice of dietetics?*
- Yes
- No
If you have answered "yes", please provide the following information.
Dietitians of Canada #
Provincial Regulatory Body
#
American #
International
#

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J: Login Information
Please enter your preferred username for the members only side of the SDA website. Once your application is processed you will receive an email with your password. You will be able to reset the password once you are inside the Members Only section of the SDA website.
Preferred Username*
By submitting this form electronically, I agree to the following terms:
- I verify that all statements contained in this application and supporting documentation are accurate. I understand that a false or misleading statement or misrepresentation may be cause for refusal of registration, disqua1ification from the CDRE or cancellation of membership and licensure with SDA.
- I understand that I may be required to provide further documentation or information and undertake other assessments in order to determine my eligibility for registration with SDA and that SDA will contact me if additional documentation is necessary.
- I am aware that the information I have provided may be verified by SDA and that in the course of such verification, that SDA may need to disclose to third parties the information that I have provided. I consent to such disclosure by SDA and I also consent to the disclosure of my personal information by third parties to SDA that may be necessary to process my application and to verify information that I have provided.
- I am aware that personal information requested on this form is used for the purposes of administration of Labour Mobility Agreements with other regulatory authorities, administration of the Canadian Dietetic Registration Exam and generally for regulatory activities under the Dietitians Act. I consent to collection, use and disclosure of my personal information for such purposes.
- I am aware that the information I have provided to SDA may be provided to eHealth Saskatchewan for their provider registry system to enable dietitian to be authorized for access to the electronic health record viewer.
- I consent to receive electronic correspondence from SDA.
- I agree to notify the SDA Board within 30 days when there are any changes to the information contained within this form.
- I agree to have my contact information added to the “Find a Member” feature on the Members Only section of the SDA website.
Terms*
- I understand and accept these terms.

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About Dietetics
About SDA
Becoming an RD in Saskatchewan
Resources
- Forms
- Canadian Dietetic Regulators

Contact Us

Phone: 306-359-3040
Email: registrar@saskdietitians.org

17-2010 7th Avenue
Regina, SK S4R 1C2

Step 1 of 10

A: General Information

B: Home Address

C: Dietetic and Related Employment

First Employer

Geographic Service Area

Second Employer

Geographic Service Area

Third Employer

Geographic Service Area

Fourth Employer

Geographic Service Area

Fifth Employer

Geographic Service Area

D: Academic Training

E: Practical Training/Internship

F: Additional Certifications

G: License & Registration

H: Canadian Dietetic Registration Exam

I: Good Standing & Professional Conduct

J: Login Information

By submitting this form electronically, I agree to the following terms:

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