2020 MAFP Advocacy and Leadership Development Program Application

Michigan Academy of Family Physicians (MAFP) is seeking candidates for its Advocacy and Leadership Development Program on Friday, December 4, 2020, in Downtown Lansing. This one-day immersion program will change the way you think about advocacy and help shape you into an advocacy leader in your clinic, institution, or community. MAFP will provide lunch and refreshments throughout the day.

REQUIREMENTS
Application eligibility is open to members of MAFP, with preference given to individuals who have not been previously engaged with MAFP committees or other Academy leadership initiatives.

Applicants must agree to attend the entire program plus take part in related follow-up activities. Upon completion of the program, participants will be required to complete and submit an Advocacy Action Plan to be implemented in 2021. The Action Plan should entail planning a grassroots activity (e.g., a breakfast at a clinic where lawmakers can interact with Family Physicians, Family Medicine residents and students). All costs related to follow-up events will be covered by MAFP.

APPLICATION DEADLINE
Interested applicants must complete the following application by Oct. 9, 2020, at 5 pm ET.

QUESTIONS?
Please call Matt Black at 517.664.9082.

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* 1. Please complete the following contact information:

First and Last Name:

Email Address:

Phone Number:

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* 2. Which of the following most closely characterizes you?

Practicing Family Physician

Family Medicine Resident

Medical Student

Other (please specify)

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* 3. Please answer the following questions:

	Yes	No
Have you participated in any MAFP events in the past (e.g. Family Medicine Advocacy Day)?	Have you participated in any MAFP events in the past (e.g. Family Medicine Advocacy Day)? Yes	Have you participated in any MAFP events in the past (e.g. Family Medicine Advocacy Day)? No
Have you served on a MAFP Committee or in any Academy leadership roles in the past?	Have you served on a MAFP Committee or in any Academy leadership roles in the past? Yes	Have you served on a MAFP Committee or in any Academy leadership roles in the past? No

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* 4. Why are you interested in participating in the MAFP Advocacy and Leadership Development Program?

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* 5. What qualities, skills or expertise do you believe make you the best individual to represent Family Physicians as an Advocacy Leader in your community?

2020 MAFP Advocacy and Leadership Development Program Application

Question Title

* 1. Please complete the following contact information:

Question Title

* 2. Which of the following most closely characterizes you?

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* 3. Please answer the following questions:

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* 4. Why are you interested in participating in the MAFP Advocacy and Leadership Development Program?

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* 5. What qualities, skills or expertise do you believe make you the best individual to represent Family Physicians as an Advocacy Leader in your community?

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* 6. How do you stay informed of the issues and concerns facing the specialty of Family Medicine?

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* 7. Do you have any additional information or comments you wish to provide?