Marywood University Seranton, Pennsylvania Department of Nutrition & Dietetics Intern Hour Reporting Form Complete this reporting form after each rotation or part of a rotation. Required Hours * ND 565: Community Nutrition - minimum 160 hours + ND 566 : Food Systems Management ~ minimum 224 hours + NDS68: MNT ‘0 Long Term Care - minimum 120 hours © Acute Care — minimum 232 hours * Professional Practice following MNT: 96 hours + Alternative Practice Experiences: please specify below = hours Ifonly a fraction of the required hours were completed at a facility — please indicate that amount of hours accomplished. Intem: Vax Uaues has completed (0. hours forthe rotation AUD) SoS Caen reuani ty Nate'hin Preceptor Signature: A A va Intem Signature: