Family Medicine Teacher of the Year Nomination Form - deadline is July 4
About your nominee for Teacher of the Year
How long have you known this doctor?
This family doctor teaches (check all that apply)
Other clinicians (NPs, PAs, RNs)
Practicing family physicians
Other connection to nominee, if not a colleague
Please tell us more about your nominee. This will serve in place of a support letter.
How does this doctor provide outstanding education?
How does this doctor serve as a role model for current and/or future family physicians?
Please add a few comments about the doctor's special attributes that you feel should be considered.
Employed Faculty Only: Describe an innovative activity that this nominee uses or created at your institution
Volunteer/Community based faculty only: Describe how this preceptor creates a positive experience for students or residents?
You can attach any supporting documents/articles/photos here. This is optional, not required.
In checking this box I give consent for IAFP staff to contact me about my nomination.
Should be Empty: