2024 ACMPE Forum Representative of the Year - Nomination Form

Background: The award recognizes a medical practice professional serving as a state MGMA ACMPE Forum Representative who has provided outstanding leadership in the education and motivation of MGMA members through the process of the ACMPE offerings. An outstanding ACMPE Forum Representative promotes and supports ACMPE efforts in the state MGMA organization by networking and conducting outreach for ACMPE in their state in partnership with MGMA and the ACMPE Certification Commission.

Eligibility: To be eligible, nominees must have served as a formal ACMPE Forum Representative for a state MGMA in the past year.

Nominating process: Nominees may be self-nominated or nominated by a professional colleague. Nominations are reviewed by the Awards Committee.

Supporting documentation: MGMA welcomes and encourages supplementary information, including letters of recommendation, documentation of goals met within the year, or proof of increased number of members achieving ACMPE advancements of certificates, certification and fellowship to support a candidate’s application.

Deadline: Nominations will be accepted between April 1-30.

Please note that all nominees must be national MGMA members and will be presented the award at the 2024 Leaders Conference in Denver, CO.

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* 1. Nominator Information:

Name

Title/Position

Organization

Address

State/Province

Email Address

Phone Number

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* 2. Nominee Information:

Name *

Title/Position

Organization

Address

State/Province *

Email Address *

Phone Number *

The MGMA ACMPE Forum Representative of the Year Award will be given to an MGMA State Forum Representative who has excelled in following categories. Please provide detailed examples of the nominee’s demonstration of outstanding characteristics or leadership in these four categories.

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* 3. Lead in delivering and educating members through and achieving the ACMPE offerings at the state level (study groups, ACMPE educational sessions during state conference, presentations etc.)

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* 4. Lead as a support and community cheerleader to the state level to those advancing through and upholding ACMPE achievements and sharing those achievements. This includes, the state MGMA website or other communication channels e.g. the states newsletter, mailings, or social channels (Campaigns, passing out fliers, emailing, mentoring etc.).

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* 5. Serve as a resource to State MGMA by setting ACMPE goals, sharing information and deadlines with state Board and members. This includes updating and reporting to state Board officials of ACMPE progress as needed and requested, creating and adapting plans to achieve state ACMPE goals as needed.

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* 6. Collaboration with state MGMA organization, MGMA, and the ACMPE Certification Commission to advance promote and grow the ACMPE offerings and to share ideas with others in the role, including but not limited to engagement in the Forum Representative Member Community and training sessions.

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* 7. MGMA welcomes and encourages supplementary information, including letters of recommendation, documentation of goals met within the year, or proof of increased number of members achieving ACMPE advancements of certificates, certification and fellowship to support a candidate’s application.

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