Utah Department of Health by R3YiEM


									About 101:   Diabetes 101 will be held Friday, November 9, 2012, as part of the last day of the Utah
             Diabetes Update Conference, co-sponsored by the American Association of Diabetes
             EducatorsUtah Chapter. The training covers:
              Introduction to Diabetes
              Complications & Co-Morbidities
              Medications and Devices
              Self-Monitoring of Blood Glucose
             Diabetes 101 also includes:
              Access to Diabetes Update Conference vendors
              Attendance at general sessions on Friday:
                     o The Plate Method
                     o The Emotional Challenge of Diabetes Care  Closing Keynote
              Networking with diabetes educators
Purpose      To improve access to, and quality of, diabetes education in Utah
Description: Up to forty (40) financial assistance awards will be granted by the Utah Diabetes
             Prevention & Control Program (DPCP). The financial assistance award covers the
              Basic training in diabetes management principles provided by local experts
              Mileage reimbursement ($0.38/mile) for those driving their own vehicle
              Reimbursement for lodging (not incidentals, such as room service) for the night of
                 Thursday, November 8, 2012 for Utah attendees traveling more than 50 miles (one
                 way) to Sandy, Utah
              Meal allowance of $16.00 for dinner on Thursday and Friday for those traveling more
                 than 100 miles (one way) to Sandy, Utah
Disclaimer: Since the American Association of Diabetes Educators-Utah Chapter and the Utah DPCP
             are both awarding financial assistance, a recipient may only receive a financial assistance
             award from one of these groups. Those serving high-risk and/or under-resourced
             communities may be given higher priority.
Eligibility: Eligible applicants include entry-level nurses, dietitians, and pharmacists. Social workers,
             physical therapists, medical assistants, health educators, and community health
             representatives are also eligible to apply. Preference is given to individuals working for
             or with the following organizations in Utah:
              Tribal diabetes programs
              Local health departments
              Community-based organizations
              Community-based and/or free clinics/hospitals
Deadline:    Application (this document) must be e-mailed to Betsi Patiño at bpatino@utah.gov by
             October 8, 2012. Applicants will be notified via e-mail by October 15 for the Utah
             DPCP financial assistance. Good luck!
                                 (place cursor in gray areas to begin typing)

Name and credentials:                 Job title:
Email address:                        Daytime phone number:
Work address, city, and state:

Number of years working in health care:
Number of years working in diabetes education:
Current employer and short description of duties and activities:

Do you serve residents of Utah?           YES             NO
Do you pay for your own CEUs?             YES             NO

Is your employer/organization paying you to attend Diabetes 101 or Diabetes Update Conference
(hourly for time, not travel)?
   YES             NO

Have you requested travel reimbursement from your employer/organization?
  YES             NO

Has your request for travel reimbursement from your employer/organization been denied?
   YES             NO

Have you ever received financial assistance to attend another Diabetes 101, Diabetes Basic Training, or
Update Conference? (Preference will be given to applicants who have not previously attended a
Diabetes 101 workshop sponsored by Utah DPCP.)
   Yes           No Is yes, for what year?

Briefly describe your professional/educational needs and/or patients’ needs that you expect to be met
through your attendance at the 2012 Diabetes 101 Training:

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