Female Leader of the Year

ACOFP Outstanding Female Leader Award

Austin, Texas | March, 2018
The ACOFP Outstanding Female Leader Award recognizes female physicians who may serve as clinical role models, educators and/or highly accomplished professional leaders and are a source of inspiration for women and men who are currently in their medical training.

These female physicians deserve recognition for their accomplishments and dedication to fostering tomorrow’s leaders in medicine.
QUALIFICATIONS

• Must be in active practice for five years or more.

• Must be a current member of the national ACOFP
REQUIREMENTS

• Completed application

• Current curriculum vitae

• At least one letter of recommendation from an ACOFP member and/or ACOFP state society. Additional letters of support are highly encouraged.
AWARD APPLICATION

All past nominees must be re-nominated each year in order to be accepted.
NOMINEE
Please complete the following for the nominee of the award.
Name of Nominee:*
YesNo
Office AddressHome Address
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Phone Number*

Area CodePhone Number
NOMINATOR
Please complete the following for the nominator of the award.
Name of Nominator:*
YesNo
Office AddressHome Address
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Phone Number*

Area CodePhone Number
Signature*
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
Completed and signed applicationCurrent curriculum vitaeOne or more letters of recommendation/support from an ACOFP member and/or ACOFP state society
Current curriculum vitae

Upload a File

Cancelof
Letter of recommendation

Upload a File

Cancelof
Additional letters of support

Upload a File

Cancelof
Completed applications are due to ACOFP by September 15, 2017.
Application materials must be uploaded above or sent to:

ACOFP
American College of Osteopathic Family Physicians
330 E. Algonquin Road, Suite 1
Arlington Heights, IL 60005
membership@acofp.org
Should be Empty:

ACOFP Outstanding Female Leader Award

AWARD APPLICATION