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 2017 for service beginning in 2018 are one registered dietitian/dietitian nutrionist, one registered nurse, one pharmacist, and one public member. Individuals elected will serve a four-year term. 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. CDEs who serve on the Board receive an extension of their certification expiration date on an annual basis until their full term is completed. At that time, a final extension of the expiration date is made for two full years, with recertification needed in the third year after the end of the term. 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. (Application approved BOD May 2015) 1
Nomination Details The NCBDE Professional Development Committee, made up of current and past Board members, interviews CDEs who submit applications. You will be contacted via email to identify a date and time for the interview. (Note: Applicants will want to add @ncbde.org as a safe sender to their email address/contact list to ensure NCBDE email 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 November 2017 Board meeting of their election, begin their term of service on January 1, 2018, and attend their first Board meeting in February 2018. The four Board meeting dates for 2018 are February 24-25, May 18-20, September 15-16, and November 3-4. Eligibility for Nomination To be eligible for nomination for the 2017 election, an applicant must be a registered dietitian/dietitian nutritionist, registered nurse, or registered pharmacist. 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, 2017 to: Attn: Professional Development Committee NCBDE 330 East Algonquin Road, Suite #4 Arlington Heights, IL 60005 * 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. Add @ncbde.org to your email 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 email 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
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, 2017. Section A: Personal and Employment Information Name Credentials Preferred Mailing Address HOME WORK Optional Race/Ethnicity Title Preferred Telephone Contact HOME CELL WORK Preferred Email Address HOME WORK Home Address City State Zip Code Home Phone Home Fax Cell Phone Home Email Employer Employer Address City State Zip Code Work Phone Work Fax Work Email 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 Application Page 1
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/Clinic 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): Average number of hours per week spent providing diabetes education (in your present position) Briefly describe your work/volunteer experience as a CDE. Briefly describe the skills and training you possess that qualify you to be a director of NCBDE. Application Page 2
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. Board and committee experience with other organizations. Application Page 3
Section E: Professional Activities, continued For one or more of the board/committee experiences described in the previous section, briefly describe some key initiatives/activities in which you were actively involved. 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 Application Page 4
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 do you define the role of a CDE? 3. How does your professional experience reflect your leadership abilities? 4. What professional roles have required you to participate as a team member; what did you learn about the concept of teamwork in those roles? 5. What are the top 3 current challenges and opportunities that exist for the CDE in today s health care environment; how do you see those evolving (if so), in the next 5-7 years? 6. What are the top 3 challenges facing NCBDE during the next 3-5 years; what are some 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 Application Page 5