Work as a dietitian in the USA: CDR RD exam route (2026)

• You hold, or will complete, a graduate degree (master's or doctorate) that a foreign degree evaluation shows is equivalent to a degree from a USDE-recognized accredited institution. CDR applies this to anyone first becoming exam eligible on or after January 1, 2024.
• You have a course-by-course evaluation of your transcript from a foreign degree evaluation agency on CDR and ACEND's approved list.
• You have completed ACEND-accredited nutrition coursework (a Didactic Program in Dietetics, Coordinated Program or Graduate Program), or an ACEND program director has reviewed your evaluation and you have made up the missing coursework.
• You have completed ACEND-accredited supervised practice: a dietetic internship, an Individualized Supervised Practice Pathway (ISPP), or the supervised practice built into a Coordinated or Graduate Program.
• Or you graduated from an ACEND International Coordinated Program (ICP) outside the US, which CDR says includes at least 1000 hours of supervised practice and makes you exam eligible on graduation. Foreign Dietitian Education (FDE) program graduates still need a US dietetic internship.
• Or you qualify through a CDR reciprocity agreement: an active Dietitians of Canada member licensed as a Canadian RD, a dietitian actively registered with the Dutch NVD, a dietitian registered by the Philippine PRC, or an INDI member in Ireland with a graduate degree from an Irish university.
• Philippine applicants for the RD exam need a foreign degree evaluation confirming a graduate degree from a Philippine university and, CDR says, documentation of at least two years' experience in nutrition or dietetics. With a bachelor's degree only, reciprocity leads to the DTR (dietetic technician) exam instead.
• Your name in CDR's records matches your government-issued photo ID exactly, as CDR warns that a mismatch can cost you the exam fee.
• To practice, you meet the licensure rules of the state where you will work, which usually include current CDR registration and may include a state law exam and a background check.

Check your route with the route finder

1. 1

   Work out which pathway fits you

   Check CDR's eligibility page first. If you are registered in Canada, the Netherlands, the Philippines or Ireland, the reciprocity route is far shorter. If not, you will use the foreign degree route, and your degree level decides how much US study you need. Getting this wrong at the start is the most common reason people spend money on the wrong evaluation or program.
2. 2

   Get a course-by-course foreign degree evaluation

   Order a detailed course-by-course evaluation from an agency on the approved list linked from CDR's eligibility page. A general document-by-document report is not enough. Ask your university to send transcripts directly to the agency, and allow for translations and international postage.
3. 3

   Have an ACEND program director review your evaluation

   CDR tells foreign-educated candidates to contact an ACEND program director (usually of a Didactic Program in Dietetics) for review. The director compares your courses with ACEND requirements and tells you what you still need to take. Programs set their own admission and English language requirements, so ask about both before enrolling.
4. 4

   Close the graduate degree gap

   If your evaluation shows a bachelor's degree only, you need a graduate degree before you can sit the RD exam. Many people choose an ACEND Graduate Program or Coordinated Program, which combine the degree, coursework and supervised practice. Check the ACEND program directory for programs that admit international students and issue the documents needed for a student visa.
5. 5

   Complete supervised practice

   Unless you are using reciprocity or graduated from an International Coordinated Program, you need an ACEND-accredited dietetic internship, ISPP, or the supervised practice inside a Coordinated or Graduate Program. Your Gulf or home-country work experience does not replace this. Internship places are competitive, so apply to several programs.
6. 6

   Establish exam eligibility with CDR

   Your program director, or for reciprocity your home association, sends CDR the confirmation it needs. You then complete an online application in CDR's Registration Eligibility Processing System (REPS). The CDR handbook says the whole process from CDR receiving your eligibility information to Pearson's Authorization to Test email takes less than a week.
7. 7

   Book and pass the RD exam

   Pay the $250 exam fee by credit card on the Pearson VUE CDR portal and book a test center in the US or at a select international location. Your authorization lasts one year. If you fail, you must reauthorize with CDR and wait 45 days before retesting.
8. 8

   Apply for a state license

   Check the dietetics board of the state where you plan to work. Texas, for example, requires current CDR registration, the Texas jurisprudence exam and a $108 license fee, and runs a criminal background check. A few states, such as California and Arizona according to CDR, have no dietitian licensure.
9. 9

   Find a job and a visa route

   Hospitals, outpatient care centers and government programs are the largest employers. Most foreign nationals need an employer to sponsor an H-1B or an immigrant petition; Canadian and Mexican citizens may use TN status. USCIS says that where a state requires a license, you generally must have it before an H-1B petition is approved.
10. 10

    Keep your credential and license current

    CDR charges an annual registration maintenance fee and requires continuing professional education through a five-year professional development portfolio. State licenses renew separately; Texas licenses, for example, are valid for two years.

• Registration Examination for Dietitians (CDR RD exam)

  A computer adaptive exam delivered by Pearson VUE at over 250 test centers in the US and select international locations. The CDR handbook says you answer between 125 and 145 questions (100 to 120 scored plus 25 unscored pretest items) in 3 hours, within a 3.5-hour appointment. You cannot go back to earlier questions. It covers four domains: Principles of Dietetics (21%), Nutrition Care for Individuals and Groups (45%), Management of Food and Nutrition Programs and Services (21%) and Foodservice Systems (13%). The minimum passing scaled score is 25 on a scale of 1 to 50, and your score appears on screen at the end.

• Registration Examination for Dietetic Technicians (DTR exam)

  A separate CDR exam for dietetic technicians. Under the Dutch and Philippine reciprocity agreements, applicants whose highest degree is a bachelor's are eligible for the DTR exam rather than the RD exam. The DTR is not the RDN credential and does not meet licensure rules that require registration as a dietitian.

• State jurisprudence exams

  Some states test knowledge of their own dietetics law. Texas requires the Texas Jurisprudence Examination, which TDLR says must be completed within 30 days of paying its registration fee. Check the board in your state.

• CDR does not list an English test score for the RD exam. The exam is delivered in English, so your working English must be strong enough for a timed clinical exam.
• ACEND-accredited universities and dietetic internships set their own English requirements for international applicants, commonly TOEFL or IELTS. Check each program's admissions page, because scores and accepted tests vary.
• Dietitians are not a VisaScreen profession, so there is no federal health care worker English certificate for this route.
• State dietetics boards generally assess your CDR registration rather than English directly. Check the board in your state in case it has its own rule for foreign-educated applicants.
• Reciprocity applicants from Canada, Ireland and the Philippines often trained in English, but CDR still expects every candidate to sit the exam in English.

Estimate your total cost

• The foreign degree evaluation and an ACEND program director's review usually take several weeks, depending on how fast your university sends transcripts.
• If you need a US graduate degree or dietetic internship, plan around program length and admission cycles. These vary by program, so check the ACEND directory; this is the longest part of the route.
• Reciprocity applicants skip US training. Once CDR has your documents, the CDR handbook says it takes less than a week to receive the Pearson Authorization to Test email, which arrives within 48 hours of approval.
• Your authorization to test lasts one year. CDR says you can retest after an unsuccessful attempt once a 45-day wait has passed, after reauthorizing.
• State licensing time varies by state. Texas licenses are valid for two years once issued.
• The Dietitian Licensure Compact has reached activation, but its website says privileges are not yet being issued; CDR expects the first compact privileges sometime in 2027.

There is no national pay scale for dietitians in the USA; employers set pay. Figures below are from the BLS Occupational Outlook Handbook for dietitians and nutritionists, based on May 2025 wage data. Pay varies widely by state, setting and specialty.

• Median annual wage (all settings)

  $76,400

  May 2025, BLS. Equivalent to $36.73 an hour.

• Lowest 10 percent

  Less than $49,090

  May 2025, BLS.

• Highest 10 percent

  More than $103,720

  May 2025, BLS.

• Outpatient care centers (median)

  $80,790

  May 2025, BLS.

• Hospitals, state, local and private (median)

  $78,180

  May 2025, BLS. Hospitals employ 27 percent of dietitians and nutritionists.

• Government (median)

  $78,070

  May 2025, BLS. Excludes education and hospitals.

• Nursing and residential care facilities (median)

  $75,670

  May 2025, BLS.

• Hospitals (state, local and private), which BLS says employ 27 percent of dietitians and nutritionists, in clinical and critical care nutrition roles.
• Government programs, such as public health and WIC nutrition services, which employ 11 percent.
• Nursing and residential care facilities, which employ 9 percent.
• Outpatient care centers, including dialysis and diabetes clinics, which employ 8 percent.
• Self-employment and private practice, which account for 9 percent, though this rarely suits visa sponsorship.
• Universities and academic medical centers, which may be cap-exempt H-1B employers.

• Dietitians are not a VisaScreen profession, so you do not need a CGFNS or TruMerit certificate for a work visa.
• The H-1B covers specialty occupations that require at least a bachelor's degree in a specific specialty. The annual cap is 65,000, plus 20,000 for people with a US master's degree or higher, and employers enter a registration selection. Universities, their affiliated nonprofits and nonprofit research organizations are not subject to the cap.
• USCIS says that if your state requires a license, you generally must have it before the H-1B petition is approved, so the RDN and state license usually come first.
• A September 2025 Presidential Proclamation added a $100,000 payment for certain new H-1B petitions for people outside the US; check the USCIS page for who it applies to before relying on an offer.
• Canadian and Mexican citizens may use TN status. The USMCA list includes Dietitian, with a baccalaureate or licenciatura degree or a state or provincial license, for up to 3 years at a time.
• For permanent residence, dietitians are not a Schedule A occupation, so employers normally need a labor certification before filing an EB-2 or EB-3 petition. This page is general information, not immigration advice; speak to an immigration attorney about your case.

1. 1

   A DHA, DOH, MOHAP, SCFHS, QCHP or other GCC dietitian license does not transfer, and no GCC authority has a reciprocity agreement with CDR. You use the foreign degree route based on the degree that first qualified you.

2. 2

   Gulf clinical experience does not replace ACEND-accredited supervised practice. It can strengthen dietetic internship applications and job interviews, and Philippine-registered dietitians may be able to count it toward the two years of experience CDR asks of PRC reciprocity applicants for the RD exam; confirm with CDR.

3. 3

   If you hold a bachelor's degree, the graduate degree rule applies to you, whatever your Gulf experience or grade. Plan a US or equivalent graduate program before budgeting for the exam.

4. 4

   Many dietitians in the Gulf are registered in the Philippines, Canada or Ireland. Keep that home registration active, because reciprocity depends on current registration and a verification statement from your home body.

5. 5

   Ask your Gulf licensing authority for a verification or good standing letter before you leave the job, in case a state board or employer asks for verification of every license you have held.

6. 6

   Start the course-by-course evaluation while you are still employed in the Gulf, as universities in India, Egypt, Lebanon or Jordan may take weeks to send sealed transcripts.

• Application plan with every step, fee and deadline

• Document checklist tailored to you, and a review of each document before upload

• Timeline built around the regulator's closure windows and document validity periods

• Help completing the application forms accurately and consistently

• Support with profession-specific evidence, such as the HCPC standards of proficiency mapping

• Guidance on certificates of good standing, references and certified translations

• Preparation for identity checks and declarations on health and character

• Tracking your application and help responding to regulator requests

• Next steps after the decision: exams, adaptation, PIN or licence and your first job

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