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 2018
Nomination Letter
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 350MB
Your First and Last Name*
First Last
Your Family Doctors Name*
First Last
Your telephone number*
City where you live*
Your email address*

How did you hear about this award?*
Information in my doctor's office
Facebook
Twitter
If Other, please specify.
Are you willing to be contacted to participate in future surveys by the BC College of Family Physicians?*
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
If you do not receive a confirmation email within 2 business days that your nomination was received please contact office@bccfp.bc.ca
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First Five Years of Practice Award
First Five Years of Practice
The First Five Years of Practice Award recognizes the accomplishments of a BC family physician in his/her first five years of practice. All nominations for 2018 must be submitted by March 31.
Award criteria:

This award will be awarded annually to a family physician in the first five years of practice who is a BCCFP member.

A nominator is required.

Each nomination must include a short paragraph (three to five sentences) describing why the nominee deserves this award.

Nominee's Name*
First and Last Name
CFPC Membership #
if applicable
City*
Phone*
Email*

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

Reason for nomination*
Please give a brief description on how this nominee is deserving of this award.
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 office@bccfp.bc.ca
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Innovations in Primary Care Award
Innovations in Primary Care Award
This award will recognize a BCCFP member who is working on local innovations in practice or health care delivery that improves patient, family, or community care. Nominations can come from a team member or colleague. You do not have to be a family physician to make a nomination. All nominations for 2018 must be received by March 31.
Award criteria:

This award will be awarded annually, if satisfactory nominations are received.

A nominator is required. A member of the team can provide the nomination.

Nominee's Name*
Name of Person
Please provide name of the contact person for this nomination.
First and Last Name
City*
Phone*
Email*

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

Are you a member of the team being nominated?
Yes
No
Reason for Nomination
Please give a brief description on how the nominee's local innovations are leading to improvements in patient, family, or community care.
Nomination Letter/Package
If you would like to do so please upload a cover letter providing more information.

Please upload all of your documents here.

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

Maximum file upload size 350MB

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 office@bccfp.bc.ca
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Medical Student Nomination
Medical Student Nomination – Deadline July 31, 2018
$1,000 BCCFP 4th Year Medical Student Scholarship
Nominee's Name*
First Last
CFPC Membership #
if applicable
Address*
City*
Province*
Postal Code*
Phone*
Email*

Is the Nominee currently a 4th Year Medical Student at UBC?*
Yes
No
Is the nominee aware of this nomination?*
Yes
No
Nominator's Name*
First Last
CFPC Membership #
if applicaable
Address*
City*
Province*
Postal Code*
Phone*
Email*

Nomination Letter
Your Nomination Letter 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

Letters of support and any other information which you feel will help the selection committee in its deliberations

If you do not receive a confirmation email within 2 business days that your nomination was received please contact office@bccfp.bc.ca
Or upload your Nomination Letter
Valid upload file extensions: .doc, .docx, .pdf Maximum file upload size 350MB

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.
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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: office@bccfp.bc.ca
Resident Nomination
Resident Nomination – Deadline April 9, 2018
Indicate which award/s you are nominating the candidate for:*
$5,000 BCCFP Resident Leadership Award
Dr. Manoo and Jean Gurjar Award $1,500 BCCFP Family Medicine Resident Scholarship
Gender*
Male
Female
Nominee's Name*
First Last
CFPC Membership #
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
NameNominator's Name*
First Last
CFPC Membership #
if applicaable
Address*
City*
Province*
Postal Code*
Phone*
Email*

Nomination Letter*
Your Nomination Letter 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

Letters of support and any other information which you feel will help the selection committee in its deliberations

If you do not receive a confirmation email within 2 business days that your nomination was received please contact office@bccfp.bc.ca
Or upload your Nomination Letter
Valid upload file extensions: .doc, .docx, .pdf Maximum file upload size 350MB

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
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Criteria for Awards
- A Nominator is required for each award and may be a family physician, fellow resident or student
- 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:
  - $5,000 BCCFP Resident Leadership Award will be presented to a UBC Family Medicine R2 graduating from the UBC Family Medicine postgraduate program
  - $1,500 Dr. Manoo and Jean Gurjar Award, BCCFP Family Medicine Resident Scholarship will be presented to both a male and a female R1 or R2 in 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: office@bccfp.bc.ca
Nomination to the Board of Directors

Step 1: Please print, sign and return this document.

Step 2: Complete this form:

If you do not receive a confirmation email within 2 business days that your nomination was received please contact office@bccfp.bc.ca

Nominations

My Family Doctor Nomination

My Family Doctor Nomination 2018

First Five Years of Practice Award

First Five Years of Practice

Innovations in Primary Care Award

Innovations in Primary Care Award

Medical Student Nomination

Medical Student Nomination – Deadline July 31, 2018

Resident Nomination

Resident Nomination – Deadline April 9, 2018

Nomination to the Board of Directors