Mentor Spotlight Award Nomination Form

Mentor Spotlight Award: 2023 Nomination Form

Nominations now open for the 2023 Mentor Spotlight Award
The Mentor Spotlight Award was designed to recognize a practicing Certified Diabetes Care and Education Specialist (CDCES) and 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.

The Nomination Process:
The nomination application must demonstrate that the mentor has displayed exemplary behaviors and characteristics in one or more of the following categories:
(1) Commitment, (2) Diversity, and/or (3) Career Guidance

Mentor nominations for the 2023 Mentor Spotlight Award will be accepted from the following:
>CBCDE mentees, past and present, who have participated, or are currently participating in the CBDCE Mentorship Program.
>Non-mentees (e.g. colleagues, another mentor) for nomination of a mentor in the CBDCE Mentorship Program.
>Mentors in the CBDCE Mentorship Program may self-nominate. Self-nominations require endorsement letter from mentee/colleague/etc.

Select 'NEXT' to nominate a mentor. Award submission deadline: May 15, 2023.
1. As the nominator, please provide us with your details.*

First NameLast Name
1a. Please enter your phone number. *
Please enter a valid phone number.
1b. Please enter your email address.*
example@example.com
1c. With permission, CBDCE publishes the names of the mentor nominators along with the mentor that was nominated. Please indicate below if you agree to having YOUR name published, as the nominating individual, on our website and in our communication materials. (We will get separate release from the nominated mentors.)*

Yes, I agree to the publishing of MY name as nominatorNO, do not publish MY name

2. Who is the mentor are you nominating? Please provide us with your mentors name.*

First NameLast Name
3. Please tell us how you are associated with the mentor nominee.*
4. Where can we reach your mentor? Please provide us with the mentors email.*
example@example.com
4a. Please provide us with your mentors phone number. *
Please enter a valid phone number.
5. Please provide us with the details on the mentorship. For example: the year(s) and place(s) mentored.*

For questions 6 - 8, select up to 3 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 350 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)
6. Selection #1: I am nominating the mentor because...

0/350
6a. Please select the appropriate category (or categories) that best describes your nomination in 6 above.

CareerCommitmentDiversity
7. Selection #2: I am nominating the mentor because...

0/350
7a. Please select the appropriate category (or categories) that best describes your nomination in 7 above.

CareerCommitmentDiversity
8. Selection #3: I am nominating the mentor because...

0/350
8a. Please select the appropriate category (or categories) that best describes your nomination in 8 above.

CareerCommitmentDiversity
Thank you for your Mentor Spotlight Award Nomination Form. Nominations submitted will be reviewed by the CBDCE Awards Committee early Summer (date TBD). You will be sent an email notification upon receipt of your nomination form.

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.

Questions?
Email us at info@cbdce.org or mluckman@cbdce.org.

Selecting SUBMIT will submit your Mentor Nomination form.
Should be Empty:

Mentor Spotlight Award: 2023 Nomination Form