MENTOR SPOTLIGHT NOMINATION FORM



Thank you for considering to nominate your CBDCE mentor for the CBDCE Mentor Spotlight Award. This Award was designed to recognize a practicing CDCES who has participated in the CBDCE Mentorship Program that has demonstrated outstanding mentorship to mentees interested in sitting for the CDCES exam. In order to qualify the nominee must have actively participated in the CBDCE Mentorship Program as a mentor, has maintained CDCES active certification status, and is in good standing. (Note that members of the CBDCE Board or Awards Committee are not eligible for this award.)


The nomination application should demonstrate that the mentor has displayed exemplary behaviors and characteristics in one or more of the following categories:


Commitment: (e.g., time and professional commitment, accessibility to mentee(s), etc.)


Diversity: (e.g., diversity of clinical experiences and work settings, support for mentee to engage in growth and enrichment opportunities such as presentations, projects, writing for publication, networking with other HCPs, connections with diabetes-related organizations, etc.)



Career Guidance: (e.g., role modeling of ethical work practices, encouragement for mentor to serve as NCBDE mentor in the future, guidance and coaching to achieve work-life balance, career goal setting, and/or career advancement of mentor.)

  

Deadline for Award Submissions: May 31, 2021


Questions on the process? Contact us at info@cbdce.org or 847-228-9795.

To nominate your mentor, please proceed with providing us with your nomination information

* As the nominator, please provide us with your name and contact information including email.
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* What mentor are you nominating? Please provide us with the mentors name.
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* Please tell us how you are associated with the mentor.
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* Where can we reach your mentor? Please provide us with the mentors email and phone number.
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* Please provide us with the details on the mentorship. For example: the year(s) and place(s) mentored.
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Next: Select up to three (3) questions from the list below to describe how the mentor has demonstrated exemplary behavior in the CBDCE Mentorship Program. For each of your selections (maximum of 3 selections), describe in 500 characters (85 words) or less, your connection with your nominee and why you feel he/she exemplifies excellence as a mentor. (Note that you do not need to select a question from each category. You may select any question/questions that best describes the mentorship.)


Describe:

* How the mentor provides opportunities and support for mentees interested in projects or presentations. (Diversity)

* How the mentor models good professional behavior for mentees he or she works with. (Commitment)

* What about the mentor makes him/her special (or the mentees)? (Commitment)

* How the mentor helps their mentee make professional connections and network with clinicians who care for individuals with diabetes. (Career)

* The impact the mentor had on your (or the mentees) clinical career. (Career)

* How has this mentor shaped your (or the mentees) career? (Career)

* How the mentor provided on-going support in reaching goals. (Commitment)

* The diversity of experience provided. (Diversity)

* The mentor's time commitment and accessibility. (Commitment)

* How the mentor supported you (or the mentees) to achieve work life balance. (Career)

* How mentor fostered the mentee as a role model for future mentoring. (Career)

Note: Each response box allows for 500 CHARACTERS (or approximately 85 words). You may submit up to three reasons why you are nominating your mentor. Enter each response reason in one of the boxes below.

* I am nominating the mentor because...
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I am nominating the mentor because...
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I am nominating the mentor because...
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Thank you for your Mentor Spotlight Award Nomination. Nominations submitted will be reviewed by the CBDCE Awards Committee. We will contact you via email should we need additional information/materials in support of your nomination. Recipient of the Mentor Spotlight Award will be recognized at CBDCE Leadership Reception at the annual ADCES meeting. 


Selecting Submit Award Nomination will submit your mentor nomination. Submission deadline is May 31, 2021.

For questions on the submission, contact info@cbdce.org or mluckman@cbdce.org.

Thank you for your submission.