About You
Help us track down our outdated links! Tell us how you were referred to this form:
First Name
Last Name
Email
Please describe yourself
Young adult with T1D, not currently in school
College/Graduate Student
Parent of a Young Adult with T1D
Clinical Provider
High School Student
Other
Other - please explain
Clinical Provider Specialty
Please select...
CDE
Dietician
Endocrinologist
Exercise Physiologist
Nurse Practitioner (NP)
Nurse/RN/Nurse Educator
Ophthalmologist/Optometrist
Physician’s Assistant (PA)
Primary Care Physician (PCP)
Social Worker
Other
What is your birthday?
When were you diagnosed with T1D?
When was your child diagnosed with T1D?
What is your child's birthday?
Would you like to be updated on CDN news and announcements?
Yes
No
Would you like to sign up for CDN's membership? It's free! As a member, you will receive:
1)
Benefits, promotions, and giveaways, from our partnering organizations and corporate members
2)
Exclusive access to internship and job openings in the diabetes sector
3)
Notifications about clinical trials and patient advisory committees looking for participants like you
4)
Alerts on new things affecting you in the diabetes community and updates from other CDN students across the country.
Yes
No
Want to join our Facebook group for teens and young adults with type 1 diabetes?
Connect with others who get it! Request to join here:
https://www.facebook.com/groups/T1DYoungAdult/
Want to join our Facebook group for parents of young adults with type 1 diabetes?
Connect with others who get it! Request to join here:
https://www.facebook.com/groups/CDNParentGroup/
Contact Information