Saskatchewan Family Physician of the Year- Nomination Form

REG L. PERKIN SASKATCHEWAN COLLEGE OF FAMILY PHYSICIAN OF THE YEAR AWARD
Each year, the Saskatchewan College of Family Physicians confers this award upon a member deemed to exemplify the ideals of family medicine. The award is adjudicated on the basis of the individual’s contribution through medicine generally, family medicine in particular, community through government, social, church or other activities as well as participation in the College of Family Physicians of Canada or the Saskatchewan College of Family Physicians.

The recipient of this award will be honoured at our Family Medicine Conference in September 2026.

Deadline for nominations: March 31st, 2026.
1. Nominator Information
Nominator's Name*

First NameLast Name
Nominator's Phone Number*

Area CodePhone Number
Nominator's Email*
example@example.com
2. Nominee's Information
Nominee's Name*

First NameLast Name
Mailing Address*
Postal Code
Nominee's Email*
example@example.com
Telephone
Year of joining CFPC:
CFPC Member Number:
Fellowship (if applicable):
Year of Certification:
Practice Profile

	Location	Dates	Types of Practice
1
2
3

Award Criteria
Eligibility Criteria
- The nomininee must have been in family practice for at least 15 years and a member of the College of Family Physicians for at least 10 years.
- Candidates may be recognized for providing exceptional care to their patients and making meaningful contributions to the health and well-being of their communities.
- Candidates may be recognized for their dedication as researchers and educators of future generations of family doctors.
- Each nominee must be community based and act as a resource to a practice population.
- Candidates must recognize the central importance of the doctor-patient relationship.
- The nominiee is not a current member of the SCFP Board or the Awards Committee.
- The nominee has NOT received this award in the past 3 years.
Questionnaire
1. How does the nominee demonstrate outstanding leadership in areas of advocacy, community service, and/or education? (examples provided may focus focus on one or more to the areas of leadership listed).*
2. Explain how the nominee supports excellence in family medicine, including community medical services and contributions beyond their medical practice to the community at large.*
3. How does the nominee exemplify the Four Principles of Family Medicine:
A. The family physician is a skilled clinician.*
B. Family medicine is a community-based discipline.*
C. The family physician is a resource to a defined practice population.*
D. The patient-physician relationship is central to the role of the family physician.*
4. Explain why this nominee deserves the Family Physician of the Year award.
SUPPLEMENTAL MATERIALS

Although not mandatory, the following elements are strongly encouraged for a nomination package (maximum 10 documents):
- A recent resume
- Patient testimonials
- Additional letters of support from peers, community organizations or groups, health professionals/administrators, etc.
- Relevant media reports, pictures, etc.
Upload documents here:

Cancelof
Should be Empty:

REG L. PERKIN SASKATCHEWAN COLLEGE OF FAMILY PHYSICIAN OF THE YEAR AWARD

1. Nominator Information

2. Nominee's Information

Practice Profile

Award Criteria

Questionnaire