Medical Nutrition Therapy
Convictions or Licensure Discipline

If you had a misdemeanor or felony conviction (other than a minor traffic violation) or had your license in any health care profession in another state revoked, suspended, limited or disciplined in any manner, you must request the following documents be sent directly to this office:

1. Official Court Record, which includes charges and disposition;
2. Copies of arrest records;
3. A letter from the applicant explaining the nature of the conviction;
4. All addiction/mental health evaluations and proof of treatment (if court ordered or voluntarily obtained); and
5. If the applicant is currently on probation, a letter from the probation officer addressing the probationary conditions and it's current status.

NOTE: If you have any criminal charges or license disciplinary actions pending that results in conviction or license discipline, you are required to report such actions to this department within 30 days.