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Dietary Manager Registration Form
Blinn College – Schulenburg Campus ATWED
100 Ranger Drive, Schulenburg, TX 78956
Phone: (979) 743-5237
Email: lorellana@blinn.edu
Select starting semester (check one):
1 (Jan–Apr) 2 (May–Aug) 3 (Sept–Dec)
Student Information
Date
Gender
Male Female
County of Residence
Social Security Number
Date of Birth
Name (Last, First, Middle)
Mailing Address
City
State
Zip
Primary Phone
Work Phone
Email
Applicant Agreement
- Attend class sessions and complete required assignments.
- Obtain required signatures from consulting dietician and administrator.
Applicant Signature
Date
Demographic Information (Optional)
Are you Hispanic or Latino?
Yes No
Race (check all that apply)
Black White American Indian/Alaskan Native
Asian Hispanic or Latino Native Hawaiian / Pacific Islander
Unknown
Consulting Dietitian Information
Name
Address
Primary Phone
Business Phone
Email
License Numbers
Administrator Information
Name
Facility Address
City, State, Zip
Business Phone
Email
Tuition and Fees
$1200.00 (covers all three semesters)
- Full refund if canceled 48 hours before start
- 80% before second class
- 50% before third class
- No refund after third class
Program Schedule
Classes meet two days per month (Thursday & Friday, 9am–4pm).
| January 2026 | May 2026 | September 2026 |
|---|---|---|
| Jan 8–9 | May 7–8 | Sep 3–4 |
| Feb 5–6 | June 4–5 | Oct 8–9 |
| Mar 5–6 | July 16–17 | Nov 5–6 |
| Apr 9–10 | Aug 6–7 | Dec 3–4 |
Note: Dates are tentative and subject to change.
Textbooks
Order from anfponline.org or call 800-323-1908.
Required:
- Nutrition Fundamentals and Medical Nutrition Therapy, 4th ed
- Foodservice Management by Design, 4th ed