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Practice Manager of the Year Application

Applications for the 2017 Practice Manager of the Year Award open on 1 March and close on 31 May.
An application form will appear below on this page between those dates.

ALL applicants (whether self-nominated or nominated by someone else) must complete this form.

In order to complete and submit the application form you will need the following:

  • Your name, contact details and AAPM Membership number
  • Practice profile (250 words)
  • Responses to the selection criteria: there is a separate response field for each criterion (approx 100-200 words for each)
  • Two (2) referee statements supporting your application from a Principal in the practice and an independent observer (200 words each)

No additional material (e.g. images, videos, other documents) may be included with the nomination. This is to ensure a fair and equitable process for all applicants. If selection panels require additional information to assist them in making a decision, all nominees will be contacted with this request.

Application Form

Please Note:

  • Use the upload buttons to submit your two referee statements
  • Larger files (1MB or more) will take a few minutes to upload
  • Enter all other details directly into the form
  • If the form is correctly completed, you will be redirected to an acknowledgement page
  • If you are not redirected (allowing sufficient time for documents to upload), this means there is an error in the form
  • Errors that need to be corrected will appear in red
Save For Later:

 

  • You do not have to complete the form in one session but may choose to "Save for Later". (See button at the bottom of the form). 
  • To save the form for later you MUST first fill out your name and contact details, including your email address. (Applicant Contact Details)
  • If you select "Save for Later" you will receive an email to the email address you have provided, with a unique link to return to your partially completed application.
  • Uploaded documents  (Referee Statements) also will NOT be saved using "Save for Later". Upload these documents only when you are ready to submit the whole form.

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Applicant Contact Details

In this section of the form, please enter your contact details as the applicant for this award.






Please select preferred title







Practice Profile


 





Responses to Selection Criteria

Please respond to each individual selection criterion below. The text tips you see in the boxes will disappear as you begin typing. The space in the boxes will expand (via a scroll bar on the right) as required. As a guideline, each response should be approximately 150-250 words.


 





 





 





 





 





 





 





 





Referee Statements

Please upload your referee statements below. They can be in Word format or may be scanned in pdf format. Each referee statement should be no more than 200 words.

 




Photo Release

AAPM and AGPAL QIP use photographs of State and National winners of the Practice Manager of the Year Award in reports and award promotion. Please read the following statement and tick the box below to indicate your permission for this, should you be one of those winners:


I grant to AAPM and AGPAL QIP the right to take photographs of me in connection with the Practice Manager of the Year Award. I also agree that AAPM and AGPAL QIP may use these photographs of me in print and/or electronically for such purposes as publicity, illustration, advertising, and Web content.

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