2009 Outstanding PA Awards - Application Form

Application Information


The deadline for completed applications -- including receipt of letters of recommendation -- is January 15. Applications received after this date will not be considered.

• Be as complete as possible when answering the questions below. If a question does not apply to your situation, simply write "N/A" in the field box.

• Make sure all dates, organization names, committee titles, etc., are clearly stated and accurate to the best of your ability.

• Include an electronic copy of the curriculum vitae (CV), if possible.  Email to lisa.jackson@texmed.org.

• Mail letters of recommendation, newspaper clippings, magazine articles, and other relevant support documents to:

TAPA Outstanding PA Awards
401 W 15th St
Austin, TX 78701-1670
(512) 370-1534

fax them to (512) 370-1626;

or email to: lisa.jackson@texmed.org

Letters of Recommendation

Letters of recommendation can come from anyone who is familiar with the nominee’s activities, such as (but not limited to)
– co-workers
– supervising physicians
– patients
– local officials such as a mayor, chief of police, EMT director, etc.
– faculty members at a PA program
– a PA student, particularly if the nominee is a preceptor
– military officers

• Letters of recommendation and the application should specify in detail why the nominee is qualified for the award. Stories about particular events of outstanding service are helpful to the judges. Here are some other examples of what could be included: 
1.    Describe the nominee’s activities, efforts, and commitment toward improving patient access to medical care. Include evidence of service beyond routine work in the practice or hospital.

2.    Describe the nominee’s personal sacrifice or level of difficulty associated with serving patients.

3.    Where appropriate, include the length of service to the community, length of service to the PA profession, or length of relationship with a given physician.

4.    Describe the nominee’s involvement in local, state, or national organizations and institutions. List past accomplishments and offices held at the community or professional level.

5.    Describe the nominee’s leadership qualities, and clinical and administrative skills.

6.    Provide examples that demonstrate the nominee’s mutual respect and teamwork with other health professionals, in particular his/her supervising physician.

7.    Include all activities by the nominee that have had a positive impact on the image of the PA profession.

 

Application Form
Please indicate the award that you are applying for: *

    

Applicant Contact Information
Full Name *
Address *
City/State/Zip *
Daytime Phone Number *
Evening Phone Number *
Email *

    

Application Information

If you have a copy of your curriculum vitae (CV), please attach.  If not, please complete Sections 1-4.
1. Employment experience to date:
2. Educational background (degrees, honors, scholarships, etc.)
3. Healthcare related leadership positions:
4. Memberships in other organizations, including awards, commendations, and offices held:

   

Reference Letters

Please provide two letters of reference related to service on behalf of the PA profession. Reference letters of e-mails may be sent separately but must arrive by the January 15 deadline.

Letters can be sent by e-mail to summers.linda@yahoo.com and lisa.jackson@texmed.org or mailed to:
    
TAPA Outstanding PA Awards
401 W 15th St
Austin, TX 78701-1670
Ph: (512) 370-1534; Fax: (512) 370-1626

    

Essay Section
1. Describe your professional achievements that demonstrate the PA profession's philosophy of providing quality, cost-effective, and accessible health care. *
2. Describe your volunteer achievements that are of local, national, or international significance that relate to the award for which you are applying. *
3. Describe any difficulties you've encountered providing care in your practice setting. *
4. If applicable, how have your activities increased accessibility to health care in a national or international practice setting.

    

For Physician-PA Team Applicants
Physician's Name:
1. Describe how you work effectively as a team to provide care.
2. Describe how patients are educated about your team's approach to providing quality care.
3. Describe how your team has served your community and the medical profession.




The receipt deadline for all completed applications is January 15.  Winners are notified by February 1, 2010.

Thank you for taking part in the Outstanding Awards Program!