Master Preceptor Award

ACOFP Master Preceptor Award

Completed applications are due to ACOFP by January 31, 2019.
The Master Preceptor Awards of the American College of Osteopathic Family Physicians recognizes preceptors for their sustained commitment to excellence in the training, education, and mentoring of osteopathic medical students in family medicine.

The purpose of this award is to recognize the dedicated practicing physicians who comprise the majority of the preceptors in our profession and is not exclusive to full-time teaching faculty of the Colleges of Osteopathic Family Medicine.

Any college of medicine may nominate qualified members for the Master PreceptorAward. The sponsor may be contacted for consultation should the Preceptorship Committee find the nominee’s application needs corrections or additional clarification. Notwithstanding any of the requirements herein stated above, the ACOFP Board of Governors shall have the authority, in its discretion, to confer the ACOFP Master Preceptor Award on an active member, in addition to those nominated by the Preceptorship Committee. The recipients of this award will be chosen by the ACOFP Preceptorship Committee with approval from the ACOFP Board of Governors from the qualified candidates.

The award recipients will be announced and recognized at the spring ACOFP Annual Convention & Scientific Seminars and receive a news release to the preceptor's local newspaper.
QUALIFICATIONS

Currently an active dues-paying ACOFP member in good standing.

Have a minimum of 10 years precepting osteopathic medical students in family medicine.
REQUIREMENTS

Copy of your current curriculum vitae with your photo.

Submit ONE letter of recommendation and verification from the sponsoring organization.
SPONSOR REQUIREMENTS

Submit ONE letter of recommendation.

A sponsorship fee of $200 must be submitted for consideration.

A suitable portion of the sponsorship fee, as determined by the ACOFP Board of Governors, may be refunded to the sponsor of an unsuccessful candidate.
PRECEPTOR INFORMATION
Please complete the following for the preceptor.
Name:*
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail:*
Phone Number:*

Area CodePhone Number
List all past and current organizations and college(s) along with dates of where you precepted in the past 10 years:*
List and describe your personal preceptorship experience in osteopathic family medicine:*
SPONSOR NOMINATOR
Please complete the following for the sponsor.
Sponsoring COM:*
Name of Sponsor:*
Address of Sponsor:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
Phone Number:*

Area CodePhone Number
Date:*

MonthDayYear
Date
Supporting Documents*

Upload
Please provide your CV, photo, and letter(s) of recommendation from the sponsoring organization. Cancelof
APPLICATION FEE
A sponsor fee of $200 must be submitted prior to consideration. A suitable portion of the fee, as determined by the ACOFP Board of Governors, may be refunded to the sponsor of an unsuccessful candidate.

Payments can be mailed, faxed or paid online:

ACOFP
Attn: Master Preceptor
330 E Algonquin Rd. Suite 1
Arlington Heights, IL 60005

Fax: 847-228-9755

Pay Online
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ACOFP Master Preceptor Award