2026_New Osteopathic Family Physician of the Year Award Application

ACOFP New Osteopathic Family Physician of the Year Award

Submission Deadline: September 15, 2025
The ACOFP New Osteopathic Family Physician of the Year Award honors a family physician who within two to five years of completing residency, has made significant contributions in family medicine. Named in memory of Michael F. Avallone, DO, FACOFP dist., this award recognizes exemplary new physicians whose leadership, service, and dedication embody the values of osteopathic family medicine.

Award qualifications include:
- Must be an active ACOFP member in good standing.
- Must have been actively practicing osteopathic family medicine for a minimum of two years and a maximum of five years.
- 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.
- Must actively serve in a leadership capacity at either the national, regional or state level.
Award requirements include:
- Submission of one letter of support from the nominator that details the nominee’s contributions to family medicine and leadership qualities.
- Submission of one letter from the nominee’s ACOFP affiliate society reflecting the nominee’s professional excellence and leadership at the local or state level. If an affiliate society is not available, a letter from a national osteopathic family medicine leader may be submitted instead.
Nominator Information
Nominator Name *
Phone Number*
Email*
example@example.com
Nominee Information
Nominee Name*

First NameLast Name
Suffix
Designation*
Company or Institution
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Email*
example@example.com
Date of completion of residency training:*

MonthDayYear
Date
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:
Name and year of national, regional, or state leadership involvement (e.g., boards, committees, task forces, lecturer, etc.)*
C/V File Upload*

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Letter of Support from Nominator File Upload*

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Letter of Support from ACOFP Affiliate Society File Upload*

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Additional Letter of Support (Optional) File Upload

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Professional Head Shot Photo Upload (high-resolution images only) *

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By signing below, I certify that, to the best of my knowledge, the information provided for the nominee in this application is true and accurate.
Signature*

Clear
Date*

MonthDayYear
Date
All completed submissions must be received by September 15, 2025. Applicants will be notified of the selection results via email no later than December 1, 2025.

Please contact Tina Burk at tinab@acofp.org if you have any questions.
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ACOFP New Osteopathic Family Physician of the Year Award

Nominator Information

Nominee Information