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CDSMP Leader Training Registration

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Thank you for your interest in becoming a Chronic Disease Self-Management Program (CDSMP) Leader within your community!

The Tennessee Department of Health (TDH), Diabetes, Heart Disease and Stroke Program (1815) is proud to partner with the Office of Minority Health and Disparities Elimination and the University of Chattanooga – engAGING Communities to assist community-based and faith-based organizations support optimal health for all. During this free, 7-week virtual training, you will develop tools to lead community CDSMP workshops. The workshop goals are to build confidence in the participant’s ability to manage their health and maintain active and fulfilling lives. To learn more about Self-Management Resource Center (SMRC) and CDSMP, please visit: https://selfmanagementresource.com/programs/small-group/chronic-disease-self-management-small-group/

What are you committing to?

Attending 13, 2.5-hour Zoom video meetings using your webcam and computer speakers.
Completing homework assignments before and during the training.
Obtaining certification as an SMRC Leader by facilitating 2 participant workshops (each workshop has 6 sessions, 1 session per week for 6 weeks) within 12 months of training.

Equipment/resources required to participate in SMRC Leader Training:

Stable, fast, internet connection.
Computer and webcam (no mobile devices or telephone participation).
Good sound quality and a dedicated place to work.
Proficiency in how to use your equipment.

*If you do not have access to the required equipment/resources please contact candace.x.jones@tn.gov.

The TN Department of Health will provide you with:

Sponsorship of SMRC Leader fees (a value of $1,000.00).
Sponsorship under the ‘Tennessee Department of Health – Nashville' licensure to facilitate workshops.
SMRC materials including a copy of Living a Healthy Life with Chronic Conditions 5th Edition and other supporting materials.
Technical assistance (ex. working jointly to identify needs; responding to unique needs of organizations/leaders; navigating achievement of goals; onboarding leaders).

First Name:

* must provide value

Last Name:

* must provide value

Preferred Pronouns:

Name of the Organization you Represent:

* must provide value

Location of Organization (County):

* must provide value

Your Organization is Considered:

* must provide value

A Faith-based organization (FBO): A charitable organization or nonprofit affiliated with a religious group or inspired by religious beliefs.

A Community-based organization (CBO): Public or private non-profit resource hubs that provide specific services to the community or targeted populations within the community.

None of the above.

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Please describe any general characteristics/demographics of the population(s) served by your organization in terms of race, ethnicity, age, gender, spoken language, etc.

* must provide value

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Email Address:

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Phone Number:

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Address (Where would you like printed materials to be sent?):

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Please specify your County and State of Residence:

Preferred Attendance Dates:

* must provide value

Tuesdays or Fridays, starting January 6th or 9th, 9:00 - 11:30 am CST

Tuesdays or Thursdays, starting January 12th or 17th - 6:00 - 8:30 pm CST

No Preference

None of these work for me

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Please Check all that Apply:

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I will commit to attend 13, 2.5 hour Zoom video meetings.

I will commit to completing all homework assignments.

I commit to facilitating 2 participant workshops within 12 months of receiving training.

I have stable, fast, internet connections.

I have access to a computer with a webcam.

I have a dedicated place to participate in the virtual training sessions.

I understand that I will not be compensated for my time but will receive SMRC Leader Training sponsorship.

Fluent Language(s) other than English:

Gender:

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Male

Female

Non-Binary

Prefer not to Answer

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Which one of these groups best represents your race?

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American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other (please specify)

Prefer not to answer

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Please Specify your Race:

Are you Hispanic or Latino?

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Yes

Prefer not to answer

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