15th Annual Chronic Disease Prevention Symposium
Health Systems Transformation: Working Together to Improve
Population Health in South Carolina
RECOGNITION AWARDS ELIGIBILITY CRITERIA:
1.
Certified Diabetes Educator of the Year Award:
Purpose:
This award recognizes a Certified Diabetes Educator who has made special contributions
in the field of diabetes education by exhibiting dedication, innovation and sensitivity in
patient care and has documented improvement in patient outcomes. This award is meant to
recognize achievements above and beyond their clinical job descriptions, and exceptional
individuals who contribute to initiatives across teams within their organization and more
broadly to the diabetes community.
Nominees should be viewed as role models and highly regarded within the community of
diabetes educators and should demonstrate exemplary innovations in patient education or
diabetes care. These innovations should have an impact on a local and statewide level.
Eligibility:
2.
Nominees must be currently employed and working in the capacity of a Certified Diabetes
Educator. The nominee must have been a Certified Diabetes Educator for at least three (3)
years.
Diabetes Champion of the Year Award:
Purpose:
This award recognizes an individual or organization for outstanding contributions to the
care of people with diabetes and/or for improving systems of care for people with diabetes.
Eligibility:
Individual nominees must have been actively engaged in clinical practice for at least three
(3) years, with attention to provision of patient-centered care based on the national diabetes
recommended standards of care (clinical and self-management education).
Organizational nominees must have made substantial advancement in improving health
care systems to improve care for patients through well-defined measures.
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15th Annual Chronic Disease Prevention Symposium Health Systems
Transformation: Working Together to Improve Population Health
in South Carolina
Friday, March 10 - Saturday, March 11, 2017
RECOGNITION AWARDS / NOMINATION APPLICATION
DEADLINE FOR SUBMISSION: FEBRUARY 15, 2017
I.
Name of Nominee: ______________________________________________________
Title: __________________________________________________________________
Organization: ___________________________________________________________
Work Address: __________________________________________________________
City: ______________________________ State: _____________
Zip: ________
Fax: (____) _____ - __________
Day Phone: (____) _____ - _________
E-mail: __________________________________
II.
Nominated for: (Please circle the appropriate award)
1. Certified Diabetes Educator of the Year Award
2. Diabetes Champion of the Year Award
III.
Name of Nominator: _________________________________________
Organization: ________________________________________________
Day Phone: (____) _____ - _______________
Fax: (____) _____ - ________________
E-mail: ______________________________________
IV.
Instructions: On the next page, please complete items 1 and 2 described below. Your response to item 1 is limited
to one page only (12 point font, double spaced). Optional item 2 does not count as part of this page limit. Any
individual, organization, or association may nominate candidates.
Describe the activities and level of effort of the nominee who merits the award for which they are being nominated,
addressing the eligibility criteria.
1. Describe the results or impact of the nominee’s work, professional contributions and accomplishments. What
were the identified outcomes? How is this work important or significant to diabetes prevention and control
efforts?
2. Optional: You may provide any supporting endorsements from individuals or organizations that
you feel are appropriate.
The nomination form must be typed. Please mail or fax the completed form to:
Felicia Greenlee Brown, Project Coordinator
Division of Diabetes, Heart Disease, Obesity and School
Health SC Department of Health and Environmental Control
2100 Bull Street
Columbia, SC 29201
803-237-5448 (office)
803-898-1690 (fax)
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RECOGNITION AWARDS NOMINATION APPLICATION
Type your responses to Questions 1 and 2 on this page.
(Use additonal paper if needed.)
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