Forms Test Page - Pennsylvania Academy of Family Physicians

PAFP Awards Nomination Form

The Fine Print

Please note: (1) Nominee must be a family physician and member of the AAFP/PAFP who has renewed their membership for 2026. (2) Nominee is an exemplary role model who has contributed significantly to the field of family medicine. (3) Selected winners must be able to attend the 2026 PAFP CONNECT Conference on April 3-4, 2026.

NOMINEE INFORMATION

Name of Nominee(Required)

First Last Credentials

Nominee Practice/ School/ Residency Program Name(Required)

Nominee Phone(Required)

Nominee Email(Required)

Enter Email Confirm Email

UPLOAD NOMINEE CV(Required)

Max. file size: 50 MB.

NOMINATOR INFORMATION (If different from above)

Name of Nominator

First Last Credentials

Nominator Practice/Medical School/ Residency Program Name

Nominator Phone

Nominator Email

Enter Email Confirm Email

View Award Criteria and Descriptions

Click on the following link to view Award Descriptions and Criteria

PAFP Physician Awards

Award Category for this Nomination(Required)

Please select the category for which you are nominating a physician.

PAFP Family Physician of the Year

PAFP Physician Leader of the Year

PAFP Exemplary Teaching Award

PAFP Community Service Award

NOMINATION NARRATIVE(Required)

If nominating yourself or another, please explain why this person deserves the award for which you are submitting the nomination. In what ways do they go above and beyond? In what ways do they inspire you or others? (500 words maximum)

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