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Saskatchewan Dietitians Association

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SDA Application Form

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.
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
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 health region in which you live/work (even if not employed with the regional health authority). This information will be used in the find a member feature on the members only side of the SDA website.
Second Employer
Position/Title
Second Employer Organization
Start Date
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 health region in which you live/work (even if not employed with the regional health authority). This information will be used in the find a member feature on the members only side of the SDA website.
Third Employer
Position/Title
Organization
Start Date
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 health region in which you live/work (even if not employed with the regional health authority). This information will be used in the find a member feature on the members only side of the SDA website.
Fourth Employer
Position/Title
Organization
Start Date
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 health region in which you live/work (even if not employed with the regional health authority). This information will be used in the find a member feature on the members only side of the SDA website.
Fifth Employer
Position/Title
Fifth Employer Organization
Start Date
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 health region in which you live/work (even if not employed with the regional health authority). This information will be used in the find a member feature on the members only side of the SDA website.

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D: Academic Training
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
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)
Certification
Year of completion
Recertification Date(if applicable)

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G: License & Registration
SDA has two types of licences: Full practising or restricted. If you are transferring from another Canadian dietetic regulatory body, apply for a full practising licence. If you are a recent graduate who has not yet written and passed the CDRE, you will be applying for a restricted licence. If you have questions as to what what type of licence you are applying for, contact the Registrar at registrar@saskdietitians.org
Type of Licence*
- Full Practicing 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*
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
Do you have any special needs/disabilities that will require an accommodation for the exam?
- 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
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 repsonible 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

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