NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS APPLICATION FOR NOMINATION TO NCBDE BOARD OF DIRECTORS

Transcription

1 NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS APPLICATION FOR NOMINATION TO NCBDE BOARD OF DIRECTORS NCBDE is pleased to provide this information about its eligibility requirements for nomination, governance structure, and board responsibilities to consider before making a decision to apply for a position on the Board of Directors. NCBDE Board of Directors The composition of the NCBDE Board of Directors (Board) is identified in the organization's bylaws: The number of Directors shall be no more than eleven voting members. These shall consist of at least nine Certified Diabetes Educators (CDEs) to include three registered nurses, three registered dietitians, one physician, one pharmacist, and one "other" professional whose discipline is other than those specified in this section. In addition, one public member and the Immediate Past-Chair serve as directors. In accordance with the bylaws, specific positions must be filled to maintain the Board composition. Positions to be filled by election in 2014 for service beginning in 2015 are one registered dietitian, one registered nurse, and one other professional. Individuals elected will serve a four year term. Those who qualify in the "other" professional category are CDEs who are clinical psychologists, occupational therapists, optometrists, physical therapists, physician assistants, podiatrists, exercise physiologists who qualified for certification with an advanced degree in exercise physiology or while holding the Registered Clinical Exercise Physiologist or Clinical Exercise Specialist credential, health educators holding the Master Certified Health Education Specialist credential, or CDEs who qualified for initial certification under a qualifying advanced degree. Director Responsibilities The primary focus of the Board is oversight of the certification program for diabetes educators, which includes the development, execution and evaluation of the organization s strategic plans and initiatives; the development, allocation and review of appropriate financial resources to support the activities of NCBDE; the development, review and approval of organizational policies and procedures to ensure successful administration of NCBDE s programs; and participation in the selection and performance evaluation of the Chief Executive Officer. Directors may also serve on committees and special task forces related to certification issues. Management and operation of the NCBDE national office are overseen by NCBDE s Chief Executive Officer. It is important to understand that those elected to the Board are expected to attend one orientation and four business meetings each year, as well as committee and task force meetings as necessary. Directors should anticipate volunteering personal time each month to devote to board activities and assignments. Service on the Board is voluntary and all expenses incurred for travel, lodging, and other meetingrelated activities are paid by NCBDE, in accordance with established policies. During term of office and for two years after completing board tenure, directors may not participate in the development or presentation of review courses, study guides, or any materials designed primarily for examination review purposes. 1

2 Nomination Details The NCBDE Professional Development Committee, made up of Board members, interviews CDEs who submit applications. You will be contacted via to identify a date and time for the interview. (Note: It is recommended that applicants as a safe sender to their address/contact list to ensure NCBDE messages are received.) The interviews typically take place in August or September. The Professional Development Committee then prepares a slate of candidates to present to the Board for election. New Directors are notified after the October 2014 Board meeting of their election, begin their term of service on January 1, 2015 and attend their first Board meeting in February The four Board meeting dates for 2015 are February 6-8 or (final date to be determined once ADA Postgraduate Course date published), May 16-17, August 29-30, and November Eligibility for Nomination To be eligible for nomination for the 2014 election, an applicant must be a registered dietitian, registered nurse, or other professional. Those who qualify in the "other" professional category are CDEs who are clinical psychologists, occupational therapists, optometrists, physical therapists, physician assistants, podiatrists, exercise physiologists who qualified for certification with an advanced degree in exercise physiology or while holding the Registered Clinical Exercise Physiologist or Clinical Exercise Specialist credential, health educators holding the Master Certified Health Education Specialist credential, or CDEs who qualified for initial certification under a qualifying advanced degree. All applicants must be diabetes educators holding active certification with NCBDE. Application Instructions: 1. Enter information neatly. 2. Complete all sections of the application. 3. Sign and date the application. 4. Submit the following with the application*: a. Copy of current curriculum vitae or resume b. Two (2) letters of recommendation from persons knowledgeable about your professional practice experience and activities in diabetes education. 5. Submit the completed application and all required documentation by mail**, postmarked no later than August 1, 2014, to: Attn: Professional Development Committee NCBDE 330 East Algonquin Road, Suite #4 Arlington Heights, IL * All required materials must accompany the application. ** Faxed materials will not be accepted. However, if you wish to also send an electronic version of the application and required documentation, you are welcome to send the electronic version to info@ncbde.org. The USPS postmark date on the mailed application will serve as final confirmation that the application was submitted prior to the deadline. 6. to your address/contact list to ensure receipt of NCBDE communications related to the application process. As part of the nomination process, applicants will be contacted by for interviews by NCBDE staff and/or the Professional Development Committee. Completion of this application does not guarantee inclusion on the final NCBDE ballot. All original documents pertaining to application are retained by NCBDE. 2

3 NATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS BOARD OF DIRECTORS APPLICATION Completed application form and all required documentation must be submitted by mail, postmarked no later than August 1, Section A: Personal and Employment Information Name Credentials Preferred Mailing Address HOME WORK Employer Employer Address Title Preferred Telephone Contact HOME WORK Preferred Address HOME WORK City State Zip Code Work Phone Work Fax Work Home Address City State Zip Code Home Phone Home Fax Home Section B: Certification Information Year of Initial CDE Certification CDE Number Year Recertified (if applicable) Current Expiration Date Section C: Education Background Highest Academic Level Completed (Associate, Bachelor s, Master s, Doctoral) Degree Earned and Year Conferred College/University Awarding Degree, City and State Major Area of Study Section D: Professional Experience in Diabetes Education INDICATE THE PRACTICE SETTING OF YOUR PRESENT EMPLOYMENT (please check all that apply) Hospital Inpatient Hospital Outpatient Both Hospital Inpatient/Outpatient Physician s Office Nursing Home/Extended Care Facility Total number of years experience in diabetes education Community Health Agency Home Health Agency Private Practice Academic/University Other (specify): Number of hours per week spent providing diabetes education (in your present position) 1

4 Section D, Professional Experience in Diabetes Education, continued Briefly describe the skills and training you possess that qualify you to be a director of NCBDE. Section E: Professional Activities In the space provided below, list diabetes education-related and other professional activities in which you have been involved. Include offices held, committee affiliations, other special projects (editorial boards, newsletters, etc.), and dates of service. National diabetes education-related activities State/local diabetes education-related activities 2

5 Section E, Professional Activities, continued Board and committee experience with other organizations Other relevant activities Section F: Professional Memberships In the space provided below, list diabetes education-related and other professional memberships that you hold. Include offices held, committee affiliations, other special projects (editorial boards, newsletters, etc.), and dates of service. Name of Organization 3

6 Section G: Applicant Statements For Section G, on a separate piece of paper, provide responses to the following: 1. Why you are interested in serving on the NCBDE Board of Directors 2. How your professional experience reflects your leadership abilities 3. What you envision will be key challenges facing NCBDE during the next 3-5 years and identify strategies to help NCBDE meet these challenges Attestation and Willingness to Serve The following statement must be signed and dated: I hereby apply for a position on the NCBDE Board of Directors and attest to the truth of all statements and information, including eligibility, provided herein. I understand that I must be currently certified by NCBDE throughout the nomination process, and, if elected, during my tenure on the Board. I understand the duties, requirements and time commitments of NCBDE Directors and willingly agree to meet these responsibilities if I am elected. Signature Date 4