CAFP Family Physician of the Year Award Nomination Form

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The California Academy of Family Physicians annually honors a family physician who represents the finest characteristics of the specialty.

Nominees for the Family Physician of the Year should:

Be recognized for work done within the previous calendar year;
Embody the finest characteristics of family medicine;
Be directly and effectively involved in public service and/or activities that enhance the quality of life in communities;
Have at least five years of practice experience;
Be in good standing as members of the medical community and CAFP.

Please submit this form and materials no later than Monday, May 1, 2024 for the 2024 award nomination.

Candidate's Contact Information

First Name

Last Name

Address (City, State, Zip)

Phone

Background Information

Medical School and Date of Completion:

Residency Program and Date of Completion:

Current Practice Setting and Total Years of Practice:

Other (if selected above):

Nomination Information

CAFP Engagement: How is the nominee engaged with CAFP? (Please include any current or previous work as a committee member, faculty, board member, etc.)

Please describe any areas of special interest of the nominee.

Briefly describe how the physician exhibits the following criteria:

(Nominations should be thorough yet concise in the information provided on the nominee. Nominations will be scored on the attributes of the nominee as well as the completeness of the nomination materials provided.)

In a few sentences, briefly describe how this nominee has demonstrated work in the last calendar year that should be recognized with this award.:

In a few sentences, briefly describe how this nominee exhibits the Characteristics of Family Medicine: Provides their patients with compassionate, comprehensive, and caring family medicine on a continuing basis.

In a few sentences, briefly describe how this nominee exhibits Public Service and Quality of Life in their Community: Is directly and effectively involved in public service and community affairs and activities that enhance the quality of their community.

In a few sentences, briefly describe how this nominee is a credible role model professionally and personally to their community, colleagues, other health professionals, and FM residents and medical students.

In a few sentences, briefly describe how this nominee exhibits can effectively represent the specialty of family medicine, and is currently in good standing as a member of the medical community and CAFP.

Please upload a photo of the candidate.

Please upload at least 1 Letter of Support as a Word document or PDF (consider letters from students, colleagues, members of the community and/or others directly involved in the nominee’s endeavors):

Please upload Candidate's CV as a Word document or PDF

Submit

Terms & Information: (Please check the box that you have read through the process information and agree.)

Yes, I agree.

CAFP’s Staff will submit nominee packets to the Membership Engagement Committee for review and selection. The California Family Physician of the Year may be asked to serve as a representative to the media, to write articles for California Family Physician, speak to student and resident groups and local chapters, or present a scientific lecture at the Family Medicine POP. CAFP’s Family Physician of the Year may also be nominated for the AAFP Family Physician of the Year award.

Process information:

Individuals may nominate themselves or another individual for the CAFP Family Physician of the Year award.
Nominees must be current members of AAFP and CAFP.
Nominators will receive notification of nomination delivery, and may be contacted for any necessary follow-up.
Nominees will receive notification of nomination.
Nominators and nominees will receive notification of award selection decision prior to public release.
The selected Family Physician of the Year will be featured in an issue of the California Family Physician magazine and recognized at an in-person CAFP event. (For 2024, the FP of the Year will be recognized at the 2024 POP event on August 23-25, 2024. For more information on POP, visit www.familydocs.org/pop.)

Name of Person Submitting Nomination:

Email of Person Submitting Nomination

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Contact Information