2024_Master Preceptor Award of the ACOFP

The Master Preceptor Award of the ACOFP

The Master Preceptor Awards of the ACOFP recognizes preceptors for their sustained commitment to excellence in the training, education, and mentoring of osteopathic medical students in family medicine. The purpose of this award is to recognize the dedicated practicing physicians who comprise the majority of the preceptors in our profession and is not exclusive to full-time teaching faculty of the colleges of osteopathic family medicine.
Award qualifications include:
- Must be an active ACOFP member in good standing.
- Must be currently certified in family medicine by the American Osteopathic Association (AOA) or the American Board of Medical Specialists (ABMS).
- Must have no current restrictions on any medical licenses at the time of application.
Award requirements include:
- Submission of one letter of support from the nominator about their commitment to excellence in the training, education, and mentoring of osteopathic medical students in family medicine.
- Submission of one letter from the nominee's sponsoring company or institution about their commitment to excellence in the training, education, and mentoring of osteopathic medical students in family medicine.
- The sponsor fee for the award is $200, and ACOFP will send an invoice to the sponsoring company or institution.
Sponsoring Company or Institution Information
Company or Institution Name:*
Sponsor Contact Name*

First NameLast Name
Sponsor Contact Email*
example@example.com
Sponsor Contact Phone Number*
Please enter a valid phone number.
Master Preceptor Nominee Information
Full Name:*

First NameLast Name
Designation*
Company or Institution Name:
AOA ID#:
Email Address:*
example@example.com
Phone Number:*
Street Address:*
City:*
State:*
Zip Code:*
Is the nominee currently certified in family medicine by the AOA or ABMS?*

YesNo
List of current active state medical licenses of nominee*
Does the nominee have any current restrictions against their medical licenses?*

YesNo
If yes, please provide an explanation:
Has the nominee had any restrictions within the past two years against their medical licenses?*

YesNo
If yes, please provide an explanation:
C/V File Upload*

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Letter of Support from Nominator Upload:*

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Letter of Support from Nominators Sponsoring Company or Institution Upload:*

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Additional Letter of Support from Upload (optional):

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Professional Headshot Photo (high resolution photos only)*

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By signing below, I certify that, to the best of my knowledge, the information provided for the nomineein this application is true and accurate.
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All completed submissions must be received by September 15, 2024. Applicants will be notified of the selection results via email no later than December 1, 2024.

Please email jessicaw@acofp.org if you have any questions.
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The Master Preceptor Award of the ACOFP

Sponsoring Company or Institution Information

Master Preceptor Nominee Information