NYACP Council Nominations Bio-Sketch Form 2020

To Be Eligible for a Council Seat:

  • The nominee must be a Fellow or Master of the College (FACP/MACP).
  • The nominee's ACP mailing address and zip code must be in the district or region where the seat is open.
  • Individuals may nominate themselves.
  • Submit the nominee's name and the bio-sketch form in lieu of a CV.

How to Submit a Nomination:

Please complete the applicable fields by September 30, 2019. For items 2-8, make sure to include dates of education/service where appropriate.


 

Nominee's First Name *
Nominee's Last Name *
Nominee's Email Address: *
ACP Mailing Zip Code: *
Telephone Number *
Practice Setting *
Specialty *
1.) Select Open Council Seat: (The Nominee's mailing address and zip code must be in the district or region where the seat is open) *
2.) Education:
3.) Post Doctoral Training:
4.) Certification:
5.) Present Hospital Affiliation(s):
6.) NYACP and/or ACP Activities:
7.) Hospital / Community Service:
8.) Other Appointments:
Nominator Full Name *






Fields marked with * are required.

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