Scholarship Application

The Kentucky Asthma Management Program in the Kentucky Department for Public Health through funding from the Centers for Disease Control and Prevention is collaborating with the Association of Asthma Educators to provide the National Asthma Educator Certification and Re-Certification Review Course. This course presents an in-depth review of asthma education based on the National Asthma Educator Certification Board outline. Participants will be able to:

          *Explain trends in asthma prevalence
          *Determine individual patient's levels of severity and control
          *Evaluate barriers to adherence as they apply to self-assessment and self-management of asthma
          *Optimize a plan of care for patients with asthma, using problem-based learning

This course will be held March 20th - 21st at the Kentucky Association of Counties, Frankfort, KY 

The Kentucky Asthma Management Program at the Kentucky Department for Public Health has a limited number of scholarships available. These scholarships will be awarded to participants residing in Kentucky or living in neighboring states and
currently working in Kentucky. The scholarships are intended to improve the competency those who provide asthma education and quality of asthma education in Kentucky with a focus on those participants who plan to sit for the national exam within the next year and for current AE-Cs who require CEUs for re-certification.

* 1. Name

* 2. Professional credentials

* 3. License number

* 4. Job title

* 5. Where are you currently employed?

* 6. Address for future contact

* 7. Phone Number for future contact

* 8. E-mail for follow-up

* 9. How are you currently working to improve patient access to National Heart, Lung and Blood Institute Expert Panel Review-3 Guidelines for the Diagnosis and Management of Asthma?

* 10. Have you ever participated in an Asthma Educator Review Course or Asthma Educator Institute held by the Kentucky Asthma Management Program?

* 11. If you answered yes to the previous question, did you receive a scholarship from the Kentucky Asthma Management Program to participate in the training?

* 12. What year or years have you previously participated in the annual review course offered by the Kentucky Asthma Management Program?

* 13. Have you successfully passed the National Asthma Educator Certification Board exam?

* 14. If you are a certified asthma educator (AE-C) who participated in an annual review course held by the Kentucky Asthma Management Program in the past 8 years, was the training beneficial in helping you pass the national exam?

* 15. Is asthma educator certification (AE-C) required for your current job?

* 16. If you are currently a certified asthma educator (AE-C), do you plan to get re-certified?

* 17. If you are not a certified asthma educator (AE-C), when do you plan to take the National Asthma Educator Certification Board exam?

* 18. How do you plan to use the training that you receive in the Kentucky Asthma Management Program Asthma Educator Review Course?

* 19. Are you associated with the Kentucky Asthma Partnership, and if so what is your role and involvement?

* 20. If you are not currently participating, would you be willing to participate in the Kentucky Asthma Partnership?

* 21. Would you be willing to participate in a Kentucky network of certified asthma educators?

* 22. Please list what you think would be the most important functions of a statewide network of certified asthma educators.

T