2023 GAFP Resident Awards

2026 Georgia Academy of Family Physicians Keith Ellis, MD Resident Scholarship Award Nominations

Please note: Nominees must be Chief or Co-Chief Resident to be eligible to receive this scholarship award.
Name*

First NameLast NameSuffix
Email*
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AAFP ID #
Resident Award

Keith Ellis Resident Scholarship

The award nominee will be a deserving chief/co-chief resident who has been a leader in academic and community affairs. He/She should also be making outstanding contributions to the profession or community.

Candidates will be evaluated on the following:
1. Member of the GAFP in good standing, holding membership at least one year prior to the year of selection;
2. Chief/Co-Chief Resident;
3. Must be in a Georgia Residency Program
4. Completed general nomination form;
5. Nomination letter from Program Director;
6. Current Curriculum Vitate submitted by the nominator
7. Qualifications to be considered are: Academic, Clinical Expertise, Community Involement, Involvement in the Discipline of Family Medicine and Involvement in Academy Activities
Deadline to submit nominations is Friday, April 17, 2025.
Name of Nominee
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Residency Program
Year of Residency

2026 Georgia Academy of Family Physicians Keith Ellis, MD Resident Scholarship Award Nominations