Nominations

My Family Doctor Nomination
The “My Family Doctor” award honours and celebrates the doctor-patient relationship, which is central to good health care and known to help improve patient satisfaction and health outcomes.

If you value your relationship with your family doctor and want to recognize them for the impact they’ve made in your life or that of a family member, the BCCFP wants to hear your story. Nominations are being accepted until March 31, 2018.

We will be providing five awards this year, honouring a family doctor from each regional health authority across the province.

My Family Doctor Nominations Form

Please share your story in 500 words or less.
My Family Doctor Nomination Form
Nomination
Please provide some information about your family doctor, either by answering the questions below or uploading your information in a nomination letter.
What prompted you to nominate your family doctor for this award? You may wish to describe how your doctor has made a difference in your life and/or how they have impacted your local community.
Is there anything else that you would like to share about why you value your family doctor?
Or upload your nomination letter

Drop files here or

Accepted file types: doc, docx, pdf.

Valid upload file extensions: .doc, .docx, .pdf Maximum file upload size 364MB
Your Information
Your first and last name*
First Last
Your family doctor's name*
First Last
Your telephone number*
Where is your family doctor’s practice located (city or community):*
Your email address*

Would you like to hear about other opportunities to celebrate your doctor by consenting to receive emails from the BCCFP?
Yes
No
How did you hear about this award?*
Information in my doctor's office
Facebook
Twitter
If Other, please specify.
If my doctor receives an award, I give my permission for the BC College of Family Physicians to use my name, along with some of the information from this nomination, to recognize my doctor’s work.*
Yes
No
Any non-personal communication or material you submit to this website by electronic mail, upload, or otherwise, including any data, questions, comments, suggestions or the like (“Submissions”) are, and will be treated as, non-confidential and non-proprietary. Anything you submit or post becomes the property of the BCCFP and the BCCFP may use and reproduce such Submission freely, and for any purpose. Specifically, BCCFP is free to use for any purposes whatsoever (including but not limited to the developing, manufacturing, advertising and marketing of products) any ideas, artwork, inventions, developments, suggestions or concepts contained in any Submission you send to this website. Any such use is without compensation to the party submitting information. By making a Submission, you are also warranting that you own the material/content submitted, that it is not defamatory and that BCCFP's use will not violate any third party's rights or otherwise place us in breach of any applicable laws. BCCFP is under no obligation to use the information submitted.*
I agree with these terms and conditions
BC Family Physician of the Year
First Five Years of Practice Award
First Five Years of Practice Nomination Form
Nominee's name*
First and Last Name
CFPC membership number
if applicable
City*
Phone*
Email*

Is the nominee aware of this nomination?*
Yes
No
Nominator's name*
First and Last Name
CFPC membership number
if applicable
City*
Phone*
Email*

Reason for nomination*
Please tell us why you are nominating this family physician for the First Five Years of Practice Award:
Nomination letter/supporting documents
Please upload your nomination letter and any supporting documents here.

Valid upload file extensions: .doc, .docx, .pdf

Maximum file upload size 64MB

Drop files here or

Accepted file types: doc, docx, pdf.

How did you hear about this award?*
BCCFP newsletter or email
Division of Family Practice
Facebook
Twitter
If other, please specify e.g. a colleague, health authority
If you do not receive a confirmation email from BCCFP within two business days, please contact [email protected]
Small Changes, Big Difference Award
Resident Nomination
Resident Nomination Form
Indicate which award/s you are nominating the candidate for:*
BCCFP R2 Resident Award ($1,500)
Dr. Manoo and Jean Gurjar Family Medicine Resident Award ($1,500)
Gender*
Male
Female
Nominee's name*
First Last
CFPC membership number
if applicable
Address*
City*
Province*
Postal code*
Phone*
Email*

The nominee is currently an*
R1
R2
At which UBC FP training site?*
Is the nominee aware of this nomination?*
Yes
No
Nominator's name*
First Last
CFPC membership number
if applicable
Address*
City*
Province*
Postal code*
Phone*
Email*

Nomination letter/supporting documents*
Your nomination letter/supporting documents should include:

The reason for your nomination

A brief biography or resume of your candidate (i.e. educational and community profile)

Evidence of your candidate’s significant characteristics relevant to the award in the form of descriptive materials, testimonials or other documentation.

Other information that will help our Awards Committee make a decision. Supporting documents could include:

Letters of support, which may be from allied professionals, patients, community members or others positively impacted by the work of the nominee

Any other information which you feel will help the selection committee in its deliberations.

If you do not receive a confirmation email within two business days that your nomination was received, please contact [email protected]
Upload your supporting letter/s*
Valid upload file extensions: .doc, .docx, .pdf Maximum file upload size 64MB

Drop files here or

Accepted file types: doc, docx, pdf.

How did you hear about this award?*
BCCFP newsletter or email
Resident Doctors of BC communications
Social media
If other, please specify e.g. a colleague, health authority
Medical Student Nomination
Medical Student Nomination Form
Nominations for the $1,000 BCCFP Medical Student Scholarship are due by June 30, 2021.
Nominee's name*
First Last
CFPC membership number
if applicable
Address*
City*
Province*
Postal code*
Phone*
Email*

Is the nominee currently a fourth-year medical student at UBC?*
Yes
No
Is the nominee entering post-graduate family medicine training in Canada?*
Yes
No
Is the nominee aware of this nomination?*
Yes
No
Nominator's name*
First Last
CFPC membership number
if applicable
Address*
City*
Province*
Postal code*
Phone*
Email*

Nomination letter/supporting documents
Your nomination letter/supporting documents should include:

The reason for your nomination

A brief biography or resume of your candidate (i.e. educational and community profile)

Evidence of your candidate’s significant characteristics relevant to the award in the form of descriptive materials, testimonials or other documentation.

Other information that will help our Awards Committee make a decision. Supporting documents could include:

Letters of support, which may be from allied professionals, patients, community members or others positively impacted by the work of the nominee

Any other information which you feel will help the selection committee in its deliberations.
Valid upload file extensions: .doc, .docx, .pdf Maximum file upload size 64MB

Drop files here or

Accepted file types: doc, docx, pdf.

How did you hear about this award?*
BCCFP newsletter or email
FMIG
Social media
If other, please specify e.g. a colleague, health authority.
Medical Student Nomination
Medical Student Nomination Form
Nominations for the $1,000 BCCFP Medical Student Scholarship are due by June 30, 2021.
Nominee's name*
First Last
CFPC membership number
if applicable
Address*
City*
Province*
Postal code*
Phone*
Email*

Is the nominee currently a fourth-year medical student at UBC?*
Yes
No
Is the nominee entering post-graduate family medicine training in Canada?*
Yes
No
Is the nominee aware of this nomination?*
Yes
No
Nominator's name*
First Last
CFPC membership number
if applicable
Address*
City*
Province*
Postal code*
Phone*
Email*

Nomination letter/supporting documents
Your nomination letter/supporting documents should include:

The reason for your nomination

A brief biography or resume of your candidate (i.e. educational and community profile)

Evidence of your candidate’s significant characteristics relevant to the award in the form of descriptive materials, testimonials or other documentation.

Other information that will help our Awards Committee make a decision. Supporting documents could include:

Letters of support, which may be from allied professionals, patients, community members or others positively impacted by the work of the nominee

Any other information which you feel will help the selection committee in its deliberations.
Valid upload file extensions: .doc, .docx, .pdf Maximum file upload size 64MB

Drop files here or

Accepted file types: doc, docx, pdf.

How did you hear about this award?*
BCCFP newsletter or email
FMIG
Social media
If other, please specify e.g. a colleague, health authority.
Criteria for Award
- A Nominator is required for each award and may be a family physician, fellow student or
  resident
- Each nomination must be accompanied by a cover letter from the Nominator addressing the
  specific reasons why the Nominee warrants the proposed recognition
- In the submission, the Nominator will ensure and confirm that the Nominee meets the required criteria for the award below:
  - $1,000 BCCFP 4th Year Medical Student Scholarship will be presented to two 4th year medical students entering the UBC Family Medicine postgraduate program.
For further information, please contact the BCCFP Office at:

Phone: 604-736-1877 or 1-888-736-1877
Email: [email protected]

Nominations

My Family Doctor Nomination

My Family Doctor Nomination Form

Nomination

Your Information

BC Family Physician of the Year

First Five Years of Practice Award

First Five Years of Practice Nomination Form

Small Changes, Big Difference Award

Resident Nomination

Resident Nomination Form

Medical Student Nomination

Medical Student Nomination Form

Medical Student Nomination

Medical Student Nomination Form