Application Memo Thank you for considering running for a national leadership position with AADE! A clear understanding of the responsibilities, expectations, and commitment required is essential prior to running for an Officer position. As a member of AADE's Governance Committee and Board of Directors, you will represent the AADE membership as well as help shape the Association's future. You will be expected to help set the strategic direction of the Association, which might include identifying programs and services for our members, adopting positions on critical issues, and making a commitment to continuous improvement on behalf of the Association. Participation on AADE's Governance Committee and Board of Directors is the most valuable gift you can give your professional organization. Officer Responsibilities Treasurer - The Treasurer will serve a one-year term beginning on the first day of the calendar year immediately following his/her election. President-elect - The President-elect will serve a three-year term beginning on the first day of the calendar year immediately following his/her election. Officer position descriptions have been posted on AADE's website to provide more detailed information on the duties and responsibilities of the position. Please take a moment to read the full position description before you begin this application. You may also want to review AADE's 2016-18 Strategic Plan, also posted on AADE's website. The skills and qualities that make someone an outstanding diabetes educator are not necessarily the same skills that will make you an outstanding Board member. When completing the application, please focus on the job description and address those competencies - not on clinical practice. Expectations and Leadership Skills for Officers Ability to meet all expectations and time commitments of this position, which includes: * Participation in quarterly Board and governing committee meetings and conference calls, as directed by the President * Willingness to represent and promote the Association without regard to professional discipline, practice, or interest * Support of AADE s Education and Research Foundation by raising or donating $500 annually
Leadership Skills Required Including, but not limited to: *Demonstrates a high level of integrity that promotes trust *Demonstrates the vision, strategic thinking, and decision making necessary to guide the association into the future *Ability to manage and build unity in times of change *Skilled communicator who can persuade, inspire and empower others *Demonstrates adaptability and flexibility in dealing with unexpected circumstances *Skilled team and relationship builder who can achieve results *Demonstrates strong organizational and management skills *Culturally competent and able to bring out the best in individuals and groups We thank you for taking the time to complete this application and your willingness to serve your professional association.
Application Instructions Each applicant must be an Active Member of AADE for a minimum of three (3) years. Active Members are defined in AADE's Bylaws (Article III, Section 2, Item A) as follows: Active Member - shall be a healthcare professional with an interest in the development, delivery or administration of diabetes patient or professional education or in diabetes research. An Active Member shall have the right to vote, to make nominations, and to chair, serve and vote on committees, and other privileges as determined by the Board of Directors. Active members who are employed by a company that is in the business of sales or marketing of diabetes pharmaceuticals, supplies or equipment shall not be eligible to stand for national elective office or a directorship position. If unsure of your membership status, please contact Sherry Lindbak at 1-800-338-3633, ext. 4803; or email at slindbak@aadenet.org. As part of this application, you will be required to submit a recent digital head shot photograph (high resolution). Please do not begin this application unless you have your head shot available to submit. Additional Information All applications will be reproduced for the ballot exactly as worded by the applicant. If you are selected for the ballot, you will not have an opportunity to proof your portion of the ballot prior to publication. Please do not submit resumes, CV's, or letters of reference/recommendation, as they will not be utilized in the review process. Incomplete applications will not be considered. Should you have any questions, please contact Sherry Lindbak at 1-800-338-3633, ext. 4803 or by email at slindbak@aadenet.org. *IMPORTANT NOTE* If you exit or "time out" of the application, you may resume completing the form using the same computer used to begin the application. However, you MUST click "SAVE/Next" for your responses on that page to be saved. If you enter information on a page without clicking "SAVE/Next", your information will not be captured by
the application system. Once you click "Submit" on the final page of this application, you will not be able enter the form or edit your responses. Submission Deadline: March 12, 2018 * 1. I affirm that I have read the applicable Officer position description(s) posted on AADE's website, and I understand the responsibilities and expectations of this role. (A "No" response will prevent you from completing this application.)
Application * 2. Please select the position for which you are applying: * 3. Full Name: * 4. Credentials: * 5. AADE Member #: * 6. Home Address: * 7. Home Phone Number: * 8. Cell / Mobile Number: * 9. Personal Email Address: * 10. Employer:
* 11. Title: * 12. Work Address: * 13. Work Phone Number: * 14. Work Email Address: * 15. Preferred Phone Number: * 16. Preferred Email Address: * 17. Please upload a current headshot. If you are selected to appear on the ballot, this photo will be included with your bio and presented to the voting members. Choose File No file chosen
Applicant's Statement * 18. Applicant's Statement: Strategic planning charges the Board and AADE to set a vision, to identify initiatives and strategies for achieving that mission, and to exert influence over an uncertain health care landscape. Last year, as part of our strategic plan, the AADE Board of Directors partnered with a branding firm in an effort to define a vision for the future of the diabetes education specialty. In 175 words or less, please provide your responses to the following: What is your vision for the future of this specialty in 10 years? Where are there opportunities and what will the challenges be? Describe the roles, responsibilities and competencies of the diabetes educator in your projection for the year 2030. What can AADE do over the next decade to support this vision? Statements that exceed the 175-word limit will not be accepted. NOTE: If selected to appear on the election ballot, your response to this question will be included with your candidate profile and made available to AADE's voting membership.
Application * 19. How many years have you been an Active Member with AADE? (You must be an Active Member for a minimum of three (3) years to run for a national office.) * 20. How many years have you worked in the field of diabetes education? * 21. Describe your current work setting(s) and summarize your responsibilities (75 word limit). Statements that exceed the 75-word limit will not be accepted.
* 22. In 150 words or less, please provide your responses to the following two-part question: What prompted you to seek a position on the 2018 ballot? Given the rapid transformation and change in the healthcare arena, AADE looks to its Board of Directors for the leadership and vision that keep the association on pace with this change. What unique perspectives or area of expertise would you hope to bring to this position? Statements that exceed the 150-word limit will not be accepted. NOTE: If selected to appear on the election ballot, your response to this question will be included with your candidate profile and made available to AADE's voting membership.
* 23. List the top three leadership skills or traits that a Board Officer should have, and give examples of how you have demonstrated that skill. (Examples should not be presented in the form of a job description.)
* 24. Please assess your knowledge, involvement, or expertise in the following areas: Little or No Involvement Some Knowledge/Experience Highly Engaged/Expert Outreach / Advocacy Strategic Planning Telehealth / Connected Health Finance / Accounting Community Service Policy Development Social Media Grant Writing Public Speaking CB / LNG Involvement AADE COIs AADE Prevention Network E-community Participation AADE Blog Population Health Diversity / Inclusion Activities
AADE Activities - National, State and Local In chronological order beginning with the most recent activity, please list UP TO ten (10) volunteer, leadership, or other roles, in which you served AADE on a national, state or local level (i.e., Editorial Board, Awards Committee, Community of Interest, etc.). Include only those activities that are related to AADE. Please format your responses according to the example below: Example: "Chair, Research Committee, January 2016 - December 2016" * 25. AADE Volunteer Service or Roles (if none, enter "N/A") 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Other Professional / Leadership Activities - National, State and Local In chronological order beginning with the most recent activity, please list UP TO ten (10) volunteer, leadership, or other roles, in which you served OTHER ORGANIZATIONS on a national, state or local level (i.e., Editorial Board, Awards Committee, chapter leadership, etc.). Do not include the AADE-related activities listed on the previous page. Please format your responses according to the example below: Example: "Chair, NCBDE, January 2016 - December 2016" * 26. Non-AADE Volunteer Service or Roles (if none, enter "N/A") 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Willingness to Serve * 27. By entering my name (electronic signature) in the space provided below, I acknowledge and agree to the following: Treasurer: If elected, I agree to serve a one-year term performing the responsibilities as previously defined. President-elect: If elected, I agree to serve a three-year term performing the responsibilities as previously defined. I understand that no member of the Board of Directors, chairperson of any of its committees, task forces, Communities of Interest, or Coordinating Bodies shall seek, nor shall he/she derive any compensation, personal profit or personal gain, directly or indirectly, to her/himself or her/his employer by reason of his or her participation with AADE. Prohibited compensation includes, but is not limited to, remuneration for services rendered as part of AADE s Core Concepts Courses. Name (Electronic Signature):
Conflict of Interest Disclosure Statement and Intellectual Property Acknowledgement Purpose To ensure the credibility and integrity of AADE, it is a necessary component of good governance that conflicts of interest or the appearance of conflicts of interest in AADE s leadership (Board, Committees, Coordinating Bodies and Communities of Interest and senior staff) be avoided. The burden of transparency requires that there be written disclosure of actual, potential and/or perceived conflicts of interest. In articulating this policy, it is not the intention of AADE to restrict the personal, professional, business or proprietary activities of AADE members. Further, it is important for the continued viability of the association that work done and decisions made by volunteers in service to AADE be held in confidence, and remain the property of AADE. Policy By accepting a role of leadership as a member of the Board of Directors, chairperson of a committee, task force or Community of Interest or Coordinating Body in AADE, you are agreeing to place the Association s interests above your own by disclosing any potential conflict or duality of interest that may arise during your term of office or appointment. Types of interest that should be disclosed include employment, membership on the Board of other national diabetes organizations or associations, advisory or consultative arrangements, speaker bureaus, stock holdings, any material external compensation and grant/research support not otherwise disclosed. For the purposes of this policy, materiality is defined as compensation that amounts to $1,000 or more per entity, per occurrence. No member of the Board of Directors, chairperson of any of its committees, task forces or Communities of Interest, or Coordinating Bodies shall seek, nor shall he/she derive any personal profit or gain, directly or indirectly, to her/himself or her/his employer by reason of his or her participation with the AADE. All members of the Board, committee, task force and Community of Interest, and Coordinating Body leaders shall refrain from obtaining any list of clients for personal or private solicitation at any time during their term. At the start of each official Board meeting, each director and officer shall disclose both in writing and orally any personal interest (as detailed above), which he or she may have and shall refrain from participation in any discussion, vote or other decision on such matter. At the start of each year, all committee, task force and Community of Interest and Coordinating Body leaders shall disclose in writing any interest they may have; at the start of each official Committee or
Community of Interest and Coordinating Body meeting, the chair shall disclose orally any change in the status of these interests. (This may include a change in employment, a consulting engagement, honorarium or stipend equal to $1,000 or more per entity, per occurrence, an appointment to a board or committee of another organization, and the like.)
Disclosure Statement * 28. Do you serve on other professional / advisory Boards, hold an office, or serve in a leadership role in another professional organization? Yes No If you answered "Yes", please provide details below.
* 29. Are you currently, or have you been at any time during the past year, or do you have any pending agreements as: i. A participant, directly or indirectly, with you or any member of your family or employer, in any arrangement, agreement, investment, or other activity with any vendor, supplier, or other party doing business with AADE, which has resulted or could result in personal benefit to you. ii. A recipient, directly or indirectly, of any salary, payments, loans or gifts of any kind or any free service, discounts, or other fees from or on behalf of any person or organization engaged in any transaction with AADE. Yes No If you answered "Yes", please provide a description of the transactions and/or the interest ("exceptions"), whether direct or indirect, including: (1) Name of Organization; (2) Period of Affiliation; and (3) Nature of Relationship * 30. Other than your employer, do you hold any official title or position in any health care related company, either for-profit or non-profit? Yes No If you answered "Yes", please list below.
31. What material revenue sources ($1,000 or more per entity, per occurrence) could impact your decision making for AADE? For the purposes of determining materiality, include estimated value of expenses paid for or reimbursed -- i.e., airfare, hotel, meals, spouse or family. Also, if you are aware of major investments or holdings in companies that may represent a conflict or influence your decisionmaking, disclose these below. Please leave blank if you have nothing to declare or disclose.
Intellectual Property Acknowledgement * 32. By selecting "Yes" below, you hereby acknowledge and agree that any original work done and/or information shared during your work with AADE shall not be divulged to any group or individual without the agreement of AADE, and shall remain the exclusive property of AADE. (A "No" response will prevent you from completing this application.) Yes No
Electronic Signature Page *STOP* Before entering your electronic signature, please use the "Previous Page" button to scroll through your submitted responses. Make any corrections at this time. Once you click "Submit", you will not be able to view or edit your application. * 33. Name (Electronic Signature): *IMPORTANT NOTE* You MUST click "Submit" at the bottom of this page to complete this application. Incomplete applications will not be accepted.