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Change in Coordinator
(ERP must be informed within 30 days of the coordinator change)
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Change in Coordinator Email Address
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Change of Address or Phone Number
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(Maximum response 255 chars, approx. 5 rows of text)
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(Maximum response 255 chars, approx. 5 rows of text)
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Name Change
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(Maximum response 255 chars, approx. 5 rows of text)
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(Maximum response 255 chars, approx. 5 rows of text)
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(Maximum response 255 chars, approx. 5 rows of text)
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(Maximum response 255 chars, approx. 5 rows of text)
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(Maximum response 255 chars, approx. 5 rows of text)
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Site Closed
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(Maximum response 255 chars, approx. 5 rows of text)
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(Maximum response 255 chars, approx. 5 rows of text)
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Site Moves to Another Sponsor or Changes in Sponsor Relationship
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Please send a letter with information about the circumstances of the move or change. You may fax this to 703-991-9120 or mail it to:
American Diabetes Association Education Recognition Program 2451 Crystal Dr. Suite 900 Crystal City, VA 22202.
State whether the program has moved intact or if there have been substantive changes in the program. If you have questions about whether your program can maintain recognition, please contact us and request a copy of the Policy on Transfer of Recognition.
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By submitting this online form, you are confirming you have reviewed the above information and attest to its accuracy.
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