NYACP Council Nominations Bio-Sketch Form 2024 | New York Chapter of the American College of Physicians

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 16, 2024. For items 2-8, make sure to include dates of education/service where appropriate.

Nominee's First Name *

Nominee's Last Name *

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) *

Nominee's Email Address: *

ACP Mailing Zip Code: *

Telephone Number *

Practice Setting *

Specialty *

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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