Marywood University ‘Scranton, Pennsy lvania Deparament of Nutrition & Dietetics Intern Hour Reporting Form ‘Complete this reporting form after each rotation or part of «rotation, Required Hours in: + ND S65: Community Nutrition ~ minimum 160 hours + ND 566 : Food Systems Management ~ minimum 224 hours + NDS68: MNT © Long Term Care ~ minimum 120 hours © Acute Care ~ minimum 232 hours + Professional Practice following MNT: 96 hours ‘+ Altemative Practice Experiences: please specify below = 4 hours If only a fraction ofthe required hours were completed at a facility — please indicate that amount of| hours accomplished. Intern: Sawa, Manges ‘has completed {for the rotation MNT Pediatrics CHOP class day (Ne mani hours Preceptor Signature: Intern Signature: