2023 Application for WIN ADA’s Professional Development Course
Answers marked with a * are required.
1. Section I: Applicant Information
  The Women's Interprofessional Network of the American Diabetes Association (WIN ADA) is ADA's members-only network for female clinicians, scientists, educators, and other health professionals in diabetes.

The WIN ADA Professional Development Course will consist of 3 virtual sessions and 1 in-person session, each 2-hours long over the course of a year. This is a professional development opportunity for early to mid-career ADA members.

Topics include: leadership skills, advocating for ourselves, networking, how to give a speech, work-life balance, imposter syndrome, how to write letters of support, and nominating women for awards. Additionally, a mentoring component will be available for participants.

Please complete this application to be considered for a position in the WIN ADA Professional Development course.

Application deadline: April 17th at 11:59 p.m. ET

You can learn more about WIN ADA at http://professional.diabetes.org/WINADA.
 
1. Applicant name: *
 
 
 
2. Current Credentials: *
 
 
 
3. Email Address: *
 
 
 
4. Current Title *
 
 
 
5. Current Place of Employment *
 
 
 
6. Are you an American Diabetes Association member? *
      
 
 
 
7. Are you a member of WIN ADA? *
      
 
 
 
8. Current City and State *
 
 
 
9. Gender: *
      
 
 
 
10. Race: *
       		 
 
 
11. Ethnicity
      
 
 
 
12. How long have you been working in the diabetes field? *
      
 
 
 
13. How would you describe your experience level in your diabetes career? *
      
 
 
 
14. What is your primary profession? *
      
 
 
 
15. What is your primary medical specialty (or the practice you work for)? We define your primary specialty as the one in which you spend the most hours. *
      
 
 
 
16. What type of research do you conduct? *
      
 
 
 
17. What are your areas of focus in your clinic and/or research? (Select all that apply) *
       		 
 
 
18. In what tract would you want leadership training? *
      
 
 
 
19. In a few sentences, why do you feel you should be part of this program? *
 
 
 
20. Do you currently have a mentor who is interested in assisting you throughout the year in conjunction with this program? (Mentors are requested to meet with you once a quarter and discuss topics related to the course.) *
 
 
 
21. If yes, what is your mentor's name and contact information?
 
 
 
22. Can you commit to attending 3 virtual 2-hour long sessions throughout the year during the weekday (Monday through Friday) and 1 in-person 2-hour long session at Scientific Sessions June 2024? *
      
 
 
 
23. What topics would you like to see covered in this leadership program?