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The award is designed to recognize and celebrate the success of an individual who has inspired and empowered other leaders through significant contributions to the healthcare industry with particular emphasis on the advancement of medical group administration, delivery and/or education.  

Requirements for nominees: Must be a long standing member of MGMA who has maintained FACMPE status, and cannot be a current member of the MGMA Board of Directors. Current board members are also disqualified from nominating until their term on the board of directors is completed.

Please note: Only completed nomination forms will be evaluated.

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* 1. Name of Nominator

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* 2. Title/Position

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* 3. Email address

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* 4. Organization

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* 5. Street Address

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* 6. City, State and Zip Code

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* 7. Phone number

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* 8. Name of Nominee

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* 9. Title/Position

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* 10. Organization

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* 11. Street Address

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* 12. City/State/Zip Code

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* 13. Phone number

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* 14. In general terms, please describe how the individual has been a catalyst for positive change in the field of medical practice management.

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* 15. Please describe in detail how the individual has been a catalyst for positive change in the field of medical practice management.

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* 16. In general terms, describe how the individual has inspired others to positively impact the transformation of healthcare in his/her community.

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* 17. Please describe in detail how the individual has inspired others to positively impact the transformation of healthcare in his/her community

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* 18. In general terms, please describe how the individual demonstrated the ability to translate success in their community to a broader contingent of professionals nationally.

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* 19. Please describe in detail how the individual demonstrated the ability to translate success in their community to a broader contingent of professionals nationally.

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* 20. Please provide documentation for this nomination justification (ie., metrics, pictures, processes, awards, etc.)

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