2015 WADE Diabetes Educator of the Year Award Nomination Form

Purpose: To recognize a member of the Washington Association of Diabetes Educators (WADE) who has inspired others in their contribution to diabetes education.

Who can nominate: Anyone can nominate a qualified candidate including a WADE member, nonmember, or her/himself.

Candidate eligibility criteria: Certified Diabetes Educator (CDE), active Member of WADE, member of AADE, and three years of experience as a diabetes educator.

Procedure: 1) Complete this application. (You may expand the answer area, if needed).

2) Submit this application to Pat Haldi () before February 20, 2015. Please include a resume with application if possible.

DATE:

Candidate information / Person submitting application
Name
Credentials
Address
Address
City, State
Zip Code
Home Phone
Work phone
AADE #
Email
Use this area to add information about the Candidate to help with the selection process. Use additional pages to fill in details. (Optional)
Contributes to diabetes education through patient care in an outstanding, unique fashion.
Example(s):
Performs in a committed and dedicated manner.
Example(s):
Consistently meets the physical, psychological, social and educational needs of patient and family. Example(s
Uses empowering teaching/learning processes in daily patient education and care of the person with diabetes. Example(s
Effectively communicates and employs active listening with patients and families.
Example(s):
Serves as a role model to the diabetes education community or helps, educates, or mentors other educators. Example(s):
Establishes an environment where learning has proven effective. Example(s):

Optional additional reasons why you think this candidate is an outstanding diabetes educator and deserves this award. The more information you can provide helps greatly with the selection.

It is recommended that you include at least one letter of support from a fellow WADE member, colleague, or employer of the candidate. (An email copy is acceptable.)

Submit this application to () by February 20, 2015.

1