Resident Leader Award
2026 Nomination Form
The Resident Leader Award recognizes an exceptional family medicine resident or fellow in Arkansas who has demonstrated outstanding leadership within the ARAFP, their residency program, and the community. This award honors a resident who is a role model among peers and is committed to advancing the mission of family medicine through service, scholarship and professionalism.
Submit by July 1
Eligibility:
Nominee must be resident members of the ARAFP and currently enrolled in a family medicine residency program in Arkansas. All nominations will be verified by the residency program director to confirm eligibility.
Nominator Information
First Name
Last Name
Institution/Organization
Relationship to Nominee
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Nominee Information
Name
First Name
Last Name
Email
example@example.com
Current Year in Residency
Residency Program
Nomination Details
LEADERSHIP DETAILS
Describe specific examples of the nominee' leadership within ARAFP, their residency program, or the broader community. Include any leadership positions held, initiatives led, or projects organized.
How has the nominee promoted or advocated for family medicine? Include example of recruitment efforts, specialty promotion, or advocacy activities.
Describe the nominee's community involvement or service activities, including volunteer work, community health initiatives, or service projects.
How has the nominee mentored or supported fellow residents? Include examples of peer mentoring, teaching, or support activities.
Additional Comments: (optional)
Nominators Signature
Thank you for taking the time to recognize outstanding leadership in family medicine!
Questions? Contact Mary Beth Rogers at mary@arkansasafp.org
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