Academy Awards Nomination Form Each year, MAFP honors outstanding individuals in the Michigan Family Medicine community who exemplify the mission, vision, and values of the Academy. The 2023 nomination period is closed. Nominations are now being accepted for 2024 nominees. Honorees will be recognized during the 2024 Michigan Family Medicine Conference & Expo, taking place in the summer of 2024. Nominating Categories & Supporting MaterialsIn addition to completing the form below, please submit* to MAFP by March 1 the following supporting materials based on the award category:Michigan Family Physician of the Year Letters of recommendation from patients, colleagues, hospital administrators, and/or community organizations CV Additional supporting materials that will help in the decision-making process Michigan Family Medicine Educator of the Year Letter(s) of recommendation from a former student or resident Letter(s) of recommendation from a family medicine educator from another institution CV Additional supporting materials that will help in the decision-making process Michigan Family Medicine Resident of the Year Letter of recommendation from the nominee's residency program director; if the nominator is the residency program director, please submit a letter of recommendation from another residency program faculty member Letter(s) of recommendation from a physician colleague, hospital administrator, patient, and/or community leader who has worked with the nominee CV Additional supporting materials that will help in the decision-making process Outstanding Medical Student in Michigan Award Letter(s) of recommendation from a non-family member CV Proof of GPA *Email supporting materials to info@mafp.com; fax to 517.347.1289; or mail to: MAFP, Attn: Academy Awards, 2164 Commons Parkway, Okemos, MI 48864. Question Title * 1. Nomination Category Michigan Family Physician of the Year Michigan Family Medicine Educator of the Year Michigan Family Medicine Resident of the Year Outstanding Medical Student in Michigan Award Question Title * 2. Nominee's Contact Information First/Last Name, Designation/Credentials City State ZIP Email Address Cell Number Question Title * 3. If the nominee is a practicing physician, select his/her primary practice type: Academic Administration Emergency Medicine Family Medicine Group Military Multi-specialty Group Research Solo Urgent Care Resident Student Other (please specify) Question Title * 4. If the nominee is a student, list his/her medical school and year of graduation: Question Title * 5. If the nominee is a resident, list his/her residency program and year of training completion: Question Title * 6. Why do you believe that this individual should receive this recognition? Question Title * 7. Please explain this individual's accomplishments and contributions to the continuing health of Michigan residents. Question Title * 8. If the nominee is a student, how has he/she demonstrated academic excellence, leadership, service, AND dedication to pursuing a career as a family physician? Question Title * 9. Nominator's Contact Information First/Last Name, Designation/Credentials Organization Title Relationship to nominee Email Address Cell Number Remember to submit the required supporting materials, based on the award category, to MAFP by March 1. Done