The FAFP Young Leader award was created in recognition of outstanding service to the Florida Academy of Family Physicians and the specialty of Family Medicine by a young physician.

All nominations must include the following information to be eligible for consideration:
  • A completed nomination form via this application
  • Current Curriculum Vitae (attached below - 5 page maximum)
  • A minimum of 250 and a maximum of 500 word letter of support.
The application and supporting documents (as noted above) must be sent together in this application and received at FAFP no later than August 1, 2022.  Questions, please contact Jennifer Young at jyoung@fafp.org or (904) 726-0944.

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* 1. Name of individual completing application (include email address):

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* 2. Physician Nominee Name:

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* 3. Physician AAFP/FAFP Member ID:

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* 4. Is the Nominee aware of the award submission?

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* 5. If the above nominee is accepted for the award, would they wish to have their name submitted to the AAFP for like award in the coming year?

*Please note that they would be required to submit additional supporting documentation to meet the AAFP's eligibility requirements.

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* 6. Physician Home Address (include address, city, state and zip code):

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* 7. Physician Home Phone Number:

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* 8. Physician Office Address (include address, city, state and zip code):

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* 9. Physician Office Phone Number:

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* 10. Physician Email address:

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* 11. Please upload a copy of the physician's CV for review (limited to 5 pages):

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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* 12. Please upload copies of supporting documentation (250-500 word letter of support or electronic recommendation supporting the candidate's qualifications based upon the eligibility requirements).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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