College Diabetes Network Ambassador Application

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Looking for more ways to support college students with T1D? Become a College Diabetes Network (CDN) Ambassador and make a huge difference in the lives of young adults with, and affected by, T1D across the country.

Thank you to Sanofi, Lexicon Pharmaceuticals, and the National Certification Board of Diabetes Educators for partnering with us on this program!

What does a CDN Ambassador do?

Act as a local resource for CDN Chapters to provide support, assistance, a friendly face, or whatever other type of help you are willing to provide. Cook a meal for your local Chapter, act as an emergency contact for members, help host a meeting - be creative!
Ensure that your local community knows about CDN programs and resources. Spread the word about CDN to your local college campuses, diabetes clinics, diabetes organizations, T1D families, and more!
Start a fundraising campaign to help keep all of CDN's programs free and accessible for all young adults with T1D, their families, clinicians, and campuses.

Who can be a CDN Ambassador?

Anyone who is not currently a college student and is passionate about supporting young adults with diabetes is welcome to sign up to be a CDN Ambassador! We especially encourage:

CDN Alumni and recent graduates with T1D
Parents of children with T1D
Clinicians and care providers who have diabetes, or work with people with diabetes
Those with strong ties to the T1D community who want to offer support\

What happens after I sign up?

After you complete this form, a CDN staff member will be in touch with information and resources to help you succeed as a CDN Ambassador!
Your information will then be added to a "Community Resources" sheet, that will be distributed to any CDN Chapters within 50 miles of you. Based on what types of support you're interested in providing, the Chapter and its student will then be able to contact you as needed.
There may not be a Chapter in your area when you sign up, but if and when a Chapter does start near you, we will share your information with them. This additional support in the startup phase of new Chapters will be invaluable as our students get established on their campuses.
You'll receive quarterly updates about the program, additional ways you can help, and stories about what other CDN Ambassadors are doing around the country!

Questions? Please email us at info@collegediabetesnetwork.org

Click "Next Page" to continue to the sign up form!

Contact Information

First Name

Last Name

Email Address

Phone Number

Street Address

City

State

Postal Code

Birthdate (mm/dd/yyyy)

Please describe yourself


CDN Alumni
Campus Administrator/Faculty
Clinical Provider
Diabetes Organization Professional
Diabetes Camp Professional
Parent of a child w/ T1D
Young Professional w/ diabetes
Other

If other, please explain.

Which of the following describes your child with T1D?

I am a person living with type 1 diabetes.

TrueFalseI would rather not say.

What is your credential/specialty? (Clinical Provider)

If other or unspecified, please explain.

In which campus department are you employed?

If other or unspecified, please explain.

In what industry are you currently employed? (optional)

If other, enter your industry of employment.

Employer

Title

Ambassador Introductory Letter

What type of support do you feel comfortable providing to local CDN Chapters? Please check all that apply.

Speaking at a Chapter meeting/eventHosting a Chapter MeetingBeing available to chat in-person or over the phone General support/advice in-person or over the phoneOther

Please explain if other.

Using the following section, write a letter to a CDN Chapter near you. Tell the Chapter a little bit about yourself, what types of support you can offer them, and your connection to type 1 diabetes. Please keep your letter brief. This will be shared with all CDN Chapters within 50 miles of you. (No more than 500 words)

Not sure what to write? Here is an example letter:

Hi there!
My name is Jane Doe and I am the parent of an 18-year old T1D who has recently gone off to college. Now that my T1D is off at college, I would like to help support other young adults with T1D as they adjust to college life, too. I am interested in helping to support your Chapter in whatever ways you need, but some specific ideas I had were:

-I would love to cook a dinner for your Chapter members and meet you all!

-I'm happy to help with outreach in the local area - I have contacts at a few of the clinics nearby and can reach out to them to see if they may be able to put the word out about your Chapter to any of their young adult patients.

-I am happy to act as an emergency contact or someone you can call if you need extra supplies, support, etc.

I look forward to hearing from you! The best way to contact me is by phone.

Sincerely,

Jane Doe

CDN Ambassador

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