The Diabetes Care and Education dietetic practice group is sponsoring a Mentor Type of diabetes usually seen in practice: Professional memberships: Please …
Be a Part of the Mentor Network
The Diabetes Care and Education dietetic practice group is sponsoring a
Mentor Network to link dietetics professionals with at least 5 years
experience in diabetes education with practitioners new to the field If
you are interested in becoming a mentor or being mentored, fill out the
attached form
DCE cannot assume any cost related to the mentoring activities once you are
matched up It is suggested that the cost of long distance phone calls or
any other expense be borne by the person being mentored
Return Forms to:
Pat Severson-Wager, MS, RD, CDN, CDE
Mentor Program Chair
preaw1234@aolcom
518 674-8213 H
Please print or type:
Please check:
I wish to be a _________Mentor
_________Mentee
Name:
____________________________________________________________________________
_______
Home address, fax, phone number and e-mail address:
| |
|
|
Business address, fax phone number and e-mail address:
| |
| |
Special interest or skills in diabetes education ie, diabetes and
pregnancy, developing materials for low-literacy populations, diabetes and
weight control, etc
| |
| |
| |
| |
Be a Part of the Mentor Network
Job history:
| |
| |
| |
|
|
| |
| |
| |
| |
| |
Type of diabetes usually seen in practice:
| |
| |
Professional memberships:
| |
| |
Please elaborate,
If Mentor: on special skills or knowledge eg, bilingual, published
articles, books, etc;
If Mentee: on area you wish to develop eg, start an education
program, write articles, etc
|
|
| |
| |
| |
| |
| |
| |
| |
