ACLM Program Certification Application

Thank you for your interest in the Lifestyle Medicine Program Certification from the American College of Lifestyle Medicine.

Programs may achieve the status of Certified or Honorable Mention, depending on their evaluation scores. Click here to view of a list of the minimum requirements necessary for achieving the status of Honorable Mention.

The full application appears below these instructions. Please read the instructions carefully and answer the questions exactly as they are asked. Applications that do not comply with the instructions will not be considered.

Process

  1. Applicants should prepare their application in a separate document. Click here to download a Word document with the application questions.
  2. Submit the application and pay the appropriate fee on the payment processing page. Click here to see a PDF of the certification fee schedule.
  3. Once the application has been submitted, it will be reviewed by three independent reviewers who will evaluate the responses and score them using ACLM’s Program Certification rubric. Questions are weighted differently depending on their importance. The final, total score will be the sum of the averages of the three reviewer’s scores for each question multiplied by the weight for each question. Applicants may be contacted by reviewers for follow-up information during the review period.

Lifestyle Medicine Certification Application

Application questions for the certification process for lifestyle medicine programs.

    There is a $1,500.00 charge to add a new post.

  • Instructions

    Please answer as completely and honestly as possible. Please use the third-person voice, as portions of your answers will be posted publicly with your profile, pending evaluation of your application. The more descriptive detail you can include with each answer the better in terms of our reviewer's understanding of your program and of the scores they assign to it.
    • Application Information

  • Contact Information

    Please provide the business and point-of-contact information for your program.
  • Please provide the name of the program or business name.
  • Please provide the physical mailing address of the business.
  • Please provide the program or business website.
  • Please provide the point of contact for communicating with ACLM about this application.
  • Please provide the email address for the point of contact.
  • Please provide the phone number for the point of contact.
  • This phone number will be the number listed publicly on your profile for your business, pending evaluation of your application.

  • Program Background

    Please provide background information on your program. Some of this information is used in evaluating and certifying programs.
  • Please select the date this program was established with the first active treatment group. You can choose Jan 1 if you are not sure of the specific day.
  • Please list the names of the program founder(s) or designer(s)
  • Please describe the training, experience, and credentials of the founder(s) that makes that individual(s) qualified to have designed this program.
  • ACLM promotes six domains of lifestyle medicine. While it is not necessary for a Certified program to address all of the pillars of lifestyle medicine, Certification does require alignment with ACLM's position for those pillars which are the focus of the program. Please describe the components of your program that address any of these pillars: (1) Whole food, plant-predominant dietary lifestyle, (2) Regular physical activity, (3) Restorative sleep, (4) Stress management, (5) Avoidance of risky substances, (6) Positive social connection
  • Are there any known side effects / negative sequelae from following the guidelines of this program? Such side effects of interest include chronic diseases and their recognized risk factors such as heart disease (blood cholesterol, blood pressure), diabetes (blood sugar), overweight/obesity, cancer, or other negative effects such as an increased need for medications.
  • Please enter the total number of current and former participants to date. Please enter a value greater than or equal to 1.

  • Program Description

    These questions are used in evaluating and certifying programs.
  • Please be as specific as possible in defining your target population based on demographics, disease condition(s), or other characteristics.
  • Are there specific criteria a potential participant must meet before being accepted into the program? (i.e., specific disease status or conditions, based on age, or unrestricted). It is not required that you have prerequisites, please just be explicit.
  • What evidence/premise was program founded upon? Please upload a succinct, 400-600 word research-based background with references. Be attentive to using proper language of attribution (i.e. Use language such as "Diet has been shown to be associated with cardiovascular mortality" if you are referencing an observational cohort study. Reserve language such as "The effects of diet on cardiovascular disease risk" or "Diet has a demonstrated effect blood lipids" or "The effects of dietary change on blood lipids have been shown to be...." when you are referencing intervention trials, preferably randomized controlled trials with at least two arms.) Please provide supporting evidence for both (1) the behavioral intervention itself, and (2) your method of delivery/administration. The word count does not include references. Please upload all documents as PDFs.
  • Are there components of this program that differentiate it from other multiple health behavior change interventions currently available or that you feel are unique? It is not required that you take a unique approach, but if you do feel something distinguishes this program from other please describe it.
  • How is the active treatment program delivered (i.e. group format, individual sessions, online, combination of above, etc.)? Please distinguish between required vs. optional or follow-up sessions.
  • Who leads/manages the treatment sessions (i.e. physician, dietician, community health worker, nurse, health coach, etc.) and what are their credentials/background/training?
  • What is the protocol, if any, for health professional oversight of medication/symptom management? If yes, please describe.
  • Please describe the duration of the active treatment program (days/weeks/months).
  • Please describe the frequency and mode of delivery of contact interactions that participants have with live program staff, as well as how many total contact hours this adds up to over the course of the active program. Active treatment is during the delivery of the core curriculum/support of the intervention and does not include the optional follow-up sessions.
  • Please describe any optional follow-up or maintenance component offered after completion of the required portion of the program. If some follow-up component exists, is there a cost to participate?
  • Metrics evaluated (i.e. height/weight, BMI, blood pressure, lipid panel, Hgb A1C, medication use/discontinuation of previous medications, etc.). How are metrics measured and by whom? If they are self-reported, what kind of instructions are given to participants?
  • How often are metrics assessed (i.e beginning, 3 months, 6 months, 12 months, 24 months, etc.)?
  • Are there organizations/institutions/corporations currently implementing the program or formally providing referrals to the program? If yes, can you provide examples, distinguish between implementation and referrals, and describe the length of time intervention has been utilized or referred to? Three or more examples are preferred.
  • Please provide three or more reference letters from organizations endorsing your program. At least one should be from a company that has used your program. Please upload all documents as PDFs.
  • Please provide one or more reference letters from a professional contact (preferably a healthcare practitioner and if possible, one who is affiliated with ACLM) who is familiar with your intervention program. Please upload all documents as PDFs.
  • Is program available in multiple languages? If so, which ones?
  • What evidence exists that this program is effective? Have papers demonstrating program efficacy or effectiveness been published in peer-reviewed journals? Please upload a brief summary of the research that has been published on your program, as well as copies of the original papers. If there are no peer-reviewed publications on this program, please outline your plans for future evaluation and research. Please upload all documents as PDFs.
  • Please upload two to five testimonials (at least four is preferred). Participants can remain anonymous. If you have not collected testimonials please explain why. Please upload all documents as PDFs.
  • How much support does/can program provide to participants and/or facilitators when questions/needs arise? How scalable are the support mechanisms when the program grows?

  • Additional Information

    These questions are for informational purposes only and are not used in evaluating or certifying programs.
  • Is program faith-based or affiliated with another specific group? If it is faith-based, is it denominational?
  • What is the cost of the program to individual participants?
  • What is the cost of the program to sponsoring organizations?
  • Is parent company a for-profit or nonprofit entity?
  • Have you evaluated any economic data (i.e. cost-effectiveness or return on investment) for the program? If yes, please describe your evaluation. If anything has been published in a peer-reviewed journal, be sure to submit the PDF in the "Evidence" field above. If you are interested in potentially publishing in the future, please describe your capacities or interest in collaborating with LMERC.
  • Please share anything else you would like to tell us. This question is not required.
  • Save Draft
    • Payment

  • Payment

    Payment options
  • Have a discount code?
  •  
    Save Draft