Emerging Physician Advocate Program Submission Form
Thank you for participating in ArMA's Emerging Physician Advocate Program. This form is your official application for recognition and award consideration — submit it only after your advocacy activities are complete. The 2025–26 tracking period runs July 15, 2025, through July 15, 2026; only activities completed within that window are eligible. Along with this form, you must upload your completed tracking sheet and supporting evidence for each claimed activity. Applications will be reviewed by the RFS & MSS Advocacy Vice-chairs, with final award determination made by ArMA's Nominations Committee.
Name
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First Name
Last Name
Email
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example@example.com
Training Level
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Please Select
Medical Student
Resident
Fellow
Institution
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Total Number of Points Earned
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A maximum of 456 points can be earned.
Upload Completed Tracking Sheet
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Upload Supporting Documents
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i.e. Screenshots, photos, certificates, etc.
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Please describe your experience participating in ArMA's Emerging Physician Advocate Program. What was the most influential activity you completed and why?
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Please answer the questions with a minimum of four sentences.
How has participating in this program changed your outlook on or understanding of physician and healthcare advocacy in Arizona?
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Please answer the questions with a minimum of four sentences.
I certify that my submission is accurate and reflective of the extent of my participation in ArMA's Emerging Physician Advocate Program.
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Yes, my submission is accurate and honest.
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