Pediatric Nutrition Care Manual® Board of Editors Application Form

Thank you for your interest in the Board of Editors for the Pediatric Nutrition Care Manual®! This survey consists of 15 questions.

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* 1. Provide the following.

Name

Credentials

Email

Employer

Job Title

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* 2. Why should you be considered for the PNCM® Board of Editors?

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* 3. Select up to 3 areas of expertise.

Breastfeeding and Lactation Support

Cleft Lip and Palate

Common Nutrient-Drug Interactions

Dysphagia

Eating Disorders

HIV/AIDS

Mood Disorders

Nutrition Care Process

Preschool Children

Pulmonary Disease

School-Age Children

Toddlers

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* 4. How many years of experience do you have in practice and/or research?

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* 5. How many years of experience do you have in the area(s) of expertise you designated above?

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* 6. Are you a current or past subscriber of NCM®/PNCM®/SNCM®?

Yes

No

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* 7. Do you have previous experience as an author?

Yes

No

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* 8. Do you have previous experience as a peer reviewer for a peer reviewed publication?

Yes

No

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* 9. Do you hold the Board Certification as a Specialist in Pediatric Nutrition (CSP) credential or certification in a specialty area relevant to the area(s) of expertise you designated above?

Yes

No

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* 10. Identify the steps of the Nutrition Care Process.

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* 11. Can you identify relevant nutrition assessment criteria, diagnoses, and interventions (ie, eNCPT) for the area(s) of expertise selected above?

Yes

No

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* 12. Do you have recent experience applying or teaching the Nutrition Care Process in a direct patient care setting?

Yes

No