AAPA Federal Service PAragon Award Application Form

AAPA FEDERAL SERVICE PARAGON AWARD APPLICATION FORM

Don't forget the deadline for receipt of completed applications for all AAPA PAragon Awards is January 15. For more information call 571-319-4401, or send an e-mail to awards@aapa.org.

For more information about the awards and the awards process, call 571-319-4401, or send an e-mail to awards@aapa.org.

Nominations for the Federal Service PA of the Year Award are made by the boards of directors of the federal service constituent organizations.

I am filling out the application with the candidate's permission:

My First Name:

My Last Name:

My E-mail Address:

I am a representative of the following federal service constituent organization:

I am the candidate nominated for a PAragon Award and am filling out the form myself.

I have been nominated for this award by the following federal service constituent organization:

Candidate Information:

* First Name:

* Last Name:

* Street Address:

* City:

* State:

* Zip Code:

* Daytime Phone Number:

AAPA ID #:

E-mail Address:

Year candidate joined AAPA:

Length of time candidate has been a PA:

Participation in Chapters:

Participation in Specialty Organizations:

Participation in Caucuses:

If you have an electronic copy of a current curriculum vitae or resume, please attach your file here. If not, please complete questions 3-6 below.

3. Employment to date:

4. Educational Background (degrees, honors, scholarships, etc.):

5. Healthcare related and other leadership positions:

6. Membership in other organizations. Include awards, commendations, and offices held.

Commitment to Patients:

7. Describe your professional achievements that demonstrate the PA profession's philosophy of providing quality, cost-effective, and accessible health care. Include all activities of local, national, or international significance that relate to this philosophy.

8. Describe your volunteer achievements that are of local, national, or international significance that relate to the award for which you are applying.

9. Describe any difficulties you've encountered providing care in your practice setting.

10. Provide evidence of your commitment to protecting human rights. (Write N/A if not applicable to the award).

11. How have your activities increased accessibility to health care in a national or international practice setting? (Write N/A if not applicable).

Letters of Recommendation:

All nominees must provide two (2) letters of recommendation related to service on behalf of the PA profession. A statement of nomination can be used as one of the letters of recommendation. The letters may be sent separately but must arrive by the January 15 deadline. Letters may be faxed to 571-319-4402, e-mailed to awards@aapa.org or sent to:

AAPA PAragon Awards
2318 Mill Road
Suite 1300
Alexandria, Virginia 22314

Please indicate below who will be sending the letters of recommendation:

The receipt deadline for all completed applications is January 15. Selections are made in February, and all applicants are notified before the end of March. If you have any questions about the awards or the awards process, please contact AAPA staff at awards@aapa.org, 571-319-4401.

How did you learn about the PAragon Awards Program? Select one.

Thank you for taking part in AAPA's PAragon Awards program!

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