Outstanding Faculty Liaison of the Year Nomination Form

Nominated Faculty Liaison Information

This award recognizes a faculty liaison who demonstrates exceptional leadership and commitment to independent pharmacy, their NCPA Chapter, and the community. Please be prepared to provide a description of the faculty liaison's contributions to the chapter this past year.

Candidates for the award must be an advisor of an NCPA Student Chapter. Please do not nominate someone who has received the award in the past five years.
Nominations are accepted from NCPA student members or self-nominations.
Nominations are due March 30. Please contact ncpaF@ncpa.org with any questions.

1. Name of NCPA Student Chapter *This question is required.

2. Nominated Faculty Liaison *This question is required.

3. Nominee's Address (street address, city, state, zip code) *This question is required.

4. Nominee's E-Mail *This question is required. This question requires a valid email address.

5. Nominee's Telephone Number *This question is required.

6. Description of faculty liaison's contributions to the chapter this past year (350 words or less). *This question is required.