2022 Family Physician of the Year Nomination Form

Nominee's Information (click the button at the bottom to submit!)

Your Information

Additional Information

Nominations must be received by Jan. 28, 2022
In your letter, please describe how the physician nominee exhibits the following criteria:
  1. Provides their patients with compassionate, comprehensive and caring family medicine on a continuing basis.
  2. Is directly and effectively involved in community affairs and activities that enhance the quality of their community.
  3. Provides a credible role model professionally and personally to their community, to other health professionals, and to residents and medical students.
  4. Can effectively represent the specialty of family medicine and the WAFP in public speaking.
  5. What characteristic makes this person stand out among their colleagues?
Nomination Requirements
  1. Completed nomination form
  2. Current curriculum vitae

Supporting Documentation
  1. Maximum of eight pages: If more than eight pages of supporting documentation are received, only the first eight pages will be used. (The nomination form and CV do not count against this total.)
  2. If submitting electronically, please scan the nomination form and all supporting documentation to one PDF file.
  3. If submitting a hard copy, please do not reduce more than two letters to a page; provide pages of photocopy-ready and reproducible quality; and do not fold materials when mailing.