Clone of ACOFP 2026-2027 Resident Governor

Resident Governor Application

for a one-year term to the 2027-2028 ACOFP Board of Governors
Full Name
AOA Number
Phone Number
Email Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RESIDENCY PROGRAM
Resident Year
Program Number
Program Name
Program Director
Program Director's Number
Osteopathic College
Year of Graduation
Signature
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
I understand that in order to have my application considered by the ACOFP Leadership Development Committee, the following items must be submitted by September 1:
- Current CV, bio & high-resolution headshot
- Two letters of support from either your family medicine program director or the department of family medicine at a college of osteopathic medicine or another faculty member/physician that has knowledge of your leadership capability.
  
  Answer the following 2 interview questions in an essay format (up to 500 words for each essay)
  - Tell us about your unique qualifications and why you are applying for the Resident Governor position?
  - How you will support ACOFP’s mission and vision should you be elected as Resident Governor? How will you hold yourself accountable to commit the time and effort necessary to be successful in this role?
    
    Answer any of the 2 following interview questions (in a Video Recorded Response)
    
    Share an experience you have had learning or working toward improving DEI efforts in your workplace or community.
    
    Explain how you encountered a problem either professionally or personally and how you proceeded to correct that problem?
    
    Tell us about a conflict you were in and how you resolved it?
    
    In what ways do you see the role of the Resident Governor being important to the ACOFP?
Application materials must be uploaded below or sent to:

Annie DeVries
Executive Assistant/Governance
American College of Osteopathic Family Physicians
8501 W. Higgins Rd., Suite 400
Chicago, IL 60631
annied@acofp.org
Current CV

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Bio

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High-Resolution Headshot

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Letters of Support

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Essay 1

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Essay 2

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Video Recorded Response or use link above

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By submitting this application, I agree to abide by the criteria listed and set by the Board of Governors of the American College of Osteopathic Family Physicians.

I hereby grant ACOFP the perpetual, absolute and irrevocable right and permission to use, reproduce, edit, exhibit, project, display, copyright, publish and/or resell photographic pictures that I provided and to circulate the same in all forms and media (including, but not limited to: on the ACOFP website and in any publications, any advertising/promotion, videotapes, audio tapes, compact discs, computer files and photographs) for educational, trade, all forms of advertising/promotion or any lawful purpose. I waive all claims to compensation and damages.
Should be Empty:

Resident Governor Application