Diabetes Conversation Maps Facilitator Kit Check Out

The Southern Nevada Health District is offering a diabetes class facilitator kit that can be checked out to Certified Diabetes Care and Education Specialists and/or facilitators trained to use Diabetes Conversation Maps Education Tools. The kit includes facilitator guides, maps, and handouts. To check out kit, complete the request form below at least two weeks prior to the pick-up date.

Diabetes Conversation Maps Facilitator Kit Check Out Form

"*" indicates required fields

Name of individual requesting kit*

First Last

Phone*

Email*

Organization Name*

Address of individual or organization*

Address City State ZIP Code

Date Kit is Needed By*

Please allow 2 weeks' notice when scheduling.

Date Kit Will Be Returned*

Southern Nevada Health District, 280 S. Decatur Blvd., Las Vegas, NV 89107

Number of participants expected to attend classes

The person or organization checking out the Southern Nevada Health District’s Diabetes Conversation maps facilitator kit accepts the responsibility for any kind of damage or loss of materials. Please initial below.*

Comments

This field is for validation purposes and should be left unchanged.

Diabetes Conversation Maps are made available by the Nevada State Division of Public and Behavioral Health through Grant Number 1 NB01OT009412-01-00 from the Centers for Disease Control and Prevention (CDC).