Application Instructions for 2020 Donna Tomky Award for Excellence in Clinical Practice

PURPOSE
This award will be given in memory of Donna Tomky, an ADCES (formerly known as AADE) Past President and Nurse Practitioner (NP), who advocated for the integration of self-management behaviors with clinical management, to a NP who continues to advance this integration through practice, health plan or health system innovation.


AWARD
  • Recipient is recognized at Annual Meeting each year
  • Recipient will receive complimentary registration to the ADCES Annual Meeting and up to $1,000 in travel expenses (subject to change)

ELIGIBILTY
  • Nominee is a Nurse Practitioner
  • Nominee is a member of ADCES
  • May have a CDE or BC-ADM credential but not required

CRITERIA
  • Must focus on the integration of self-management with clinical management
  • Incorporates AADE7 Self-care behaviors
  • Optimizes clinical management/treatment
  • Uses technology to impact care
  • Patient-centered
  • Addresses health care delivery
  • Can be a tool, a technique, a practice intervention
The nominator/applicant must address in writing how the nominee meets the criteria stated above in 150 words or less (essay).

The nominator/applicant must submit:
  • Two letters of support of not more than 500 words, from a professional colleague other than the nominator
  • CV or Resume
Applications must be submitted by March 2, 2020.

All applications must be complete to be considered. Please be sure to provide as much detail as possible in your answers. Applications demonstrating thoughtful, detailed responses tend to yield more favorable results.

An email confirmation will be sent after the completed application is received. If a confirmation has not been received by March 23, 2020, it is the applicant's responsibility to contact ADCES at awards@aadenet.org.

IMPORTANT
If you exit or "time out" of the application, you may resume completing the form on 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 and then exit without clicking "SAVE/Next", your information will be lost.

To resume your application, simply click on the "SAVE/RESUME" button on the ADCES Award Application web page.

NOTE: Once you click "Submit" on the final page of this application, you will not be able to access your application form or edit your responses.

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* 1. I am completing this application:

If you are nominating, we recommend that you inform the person and meet with them to compile their application materials and learn if there are relevant activitis that are not listed on their resume/CV.

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* 2. Nominator's Full Name
(Nominee/Applicant info will be captured on another page)

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* 3. Nominator's phone number

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* 4. Nominator's email address

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* 5. Relationship to the Applicant

Applicant (Nominee) Information

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* 6. Applicant Full Name

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* 7. Credentials

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* 8. Professional Affiliation (Employer)

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* 9. Title

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* 10. Phone Number

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* 11. Email Address

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* 12. How many years has the nominee worked in the field of diabetes care and education?

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* 13. List any ADCES (formerly known as AADE) activities in which the applicant/nominee has been involved, including committee work, published works/aticles, leadership roles, etc. Please list dates, and include local, state and national activities.

In 500 words or less, describe how the applicant/nominee:
  • Must focus on the integration of self-management with clinical management
  • Incorporates AADE7 Self-care behaviors
  • Optimizes clinical management/treatment
  • Uses technology to impact care
  • Patient-centered
  • Addresses health care delivery
  • Can be a tool, a technique, a practice intervention

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* 14. Enter below:

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* 15. Attachments: Please upload Resume/CV

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
Attachments: Please attach two letters of support.

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* 16. Attach first letter

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 17. Attach second letter

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
*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.

By entering my name (electronic signature) in the space provided before, I acknowledge and agree to the following:

I understand and agree to abide by the entry and eligibility requirements indicated. I understand that all materials submitted in conjunction with the award application will not be returned. I agree that, if selected, highlights from the application may be used by ADCES for such purposes as sharing best practices, advertising, publicity, and promotion for or solicitation of future applications.

I confirm that I am not a past receipent of this award.

I confirm that I am not a current or incoming member of the Board of Directors.

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* 18. 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.

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