National Conference Family Medicine Residents and Students (NCFMRS), and
National Congress Of Student Members (NCSM)
2017 Dates/Location: Thursday-Saturday, July 27-29; Kansas City, Missouri
Held every summer in Kansas City, MO, the “National Conference” is organized specifically for residents and students. It is a phenomenal opportunity to learn about family medicine and develop leadership skills. The Student Congress includes one Delegate and one Alternate Delegate from each state, who attend all business sessions and vote in the elections. All attendees have the opportunity to write resolutions, work with their state delegation on issues before the congress, and testify in reference committee. Students also have the opportunity to network with hundreds of residency programs, recruitment firms, health agencies, and hospitals; and attend a variety of workshops designed to improve clinical skills.
CHAPTER DELEGATE/CHAPTER ALTERNATE DELEGATE APPLICATION
Pre-Requirements:
- Must have participated in one WAFP or FMIG activity prior to application.
- Must be a student in good standing with their medical school and not on academic probation.
- Must be a student member of WAFP and AAFP.
Expectations:
- Delegate position responsibilities: attend all business sessions, poll their state delegations about issues before the congress and vote in the elections.
- Alternate Delegate position responsibilities: attend all business sessions with the Chapter Delegate and assist the Chapter Delegate. The Alternate Delegate should plan to advance to become the Chapter Delegate the following year.
- Must submit a report summarizing the experience along with an expense report from the meeting within 30 days to be reimbursed.
Application process:
- Complete the form below and sign attestation statement
- Submit a one-page letter of interest
- Signed Academic Recommendation Form (download online)
The WAFP provides 5 scholarship stipends (up to $850 each) to support student attendance at the AAFP National Conference. Completing the Delegate application also satisfies the WAFP scholarship application process.Appointment to a delegate position obligates the student to attend lectures, workshops and all of the Student Congress business sessions.
**Please note that all interested applicants should first apply for eligible AAFP Scholarships. AAFP Scholarship applications may be downloaded online**
Please return completed candidate packet to the WAFP office. You may submit the application by email to , by fax to 425-747-3109, or by mail to:1239 - 120th Ave NE, Suite G, Bellevue, WA 98005
PERSONAL INFORMATION
Student Name
Street Address
CityState/Zip
PhoneAAFP ID#
Medical School Current Year
Campus where you spent your first year of medical school
Position interested in: Chapter Delegate Alternate Delegate Either
PLEASE ANSWER THE FOLLOWING:
1.When do you expect to graduate from medical school (year)?
2.Have you attended the National Conference previously?
YesNo If yes, which year?
3.Have you applied for a scholarship from the AAFP to attend? YesNo
If yes, which scholarship? (please check)
1st time Student Attendee Award
Minority Scholarship Program for Medical Students
FMIG Leadership Award
Returning Student Scholarship
Family Medicine Leads - Emerging Leader Institute -- A Program of the AAFP Foundation
4.Please describe your past and current roles with the FMIG (Family Medicine Interest Group), or WAFP:
5.What family medicine courses have you taken so far?
6.How likely is it that you will choose family medicine as a career? (Circle one)
Not likelySomewhat likelyLikelyVery likely
7.WAFP Membership& AttestationRequirement (Please check each attestation box and sign at the bottom)
To be considered a candidate for WAFP leadership positions, or for WAFP Foundation scholarships, stipends or grants, the applicant must be a student in good standing with his/her medical school and not on academic probation. Additionally, the applicant must be a student member of the WAFP/AAFP. All applicants must complete and sign the attestation statement below. For information on AAFP/WAFP membership benefits, click here. To apply for membership, click here.
It is the mission of the WAFP and WAFPF to foster the growth and development of family medicine in Washington State, particularly in rural and underserved areas. Candidates who are elected/appointed to a WAFP or WAFP Foundation leadership position, or are awarded a scholarship or stipend, agree to the use of your medical specialty match information by WAFP/F solely for the purposes of monitoring the effectiveness of their programs. The information will be de-identified, and WAFP/F will ensure confidentiality.
Member in Good Standing
☐ I attest that I am a student member of the AAFP/WAFP; in good standing with my medical school and not on academic probation.
Notification Obligation
☐ If I become aware of any potential challenges to my student status, it is incumbent upon me to notify the WAFP President or EVP.
Release of Information
☐ I hereby authorize my medical school (listed above) to disclose in good faith all information regarding my medical school graduation and match into residency specialty/program.
Print Full Name:
Signature: Date:
8.On a separate sheet, please write an essay or statement (1-page max) indicating why you would like to represent Washington as the Chapter Delegate or Chapter Alternate Delegate to the National Conference. Please outline your educational and career interests, or other reasons for planning to attend.