Family Medicine Teacher of the Year Nomination Form - deadline is August 1
About you
Your Name
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Email Address
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Phone number
About your nominee for Teacher of the Year
Name
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Institution
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City
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Teaching role
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Employed educator
Volunteer faculty/preceptor
Important details
How long have you known this doctor?
This family doctor teaches (check all that apply)
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Me
Medical Students
Residents
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.
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