NCPA Foundation COVID-19 Vaccination Survey

Community pharmacies will play an integral role in the distribution and administration of the COVID-19 vaccine throughout the country. To facilitate this process, the NCPA Foundation is reaching out to pharmacy schools to support community pharmacies by providing students to assist in administering the vaccine. Let us know if your pharmacy would be interested in working with students on this very important program. Please note, responding to this survey does not guarantee student availability.

1. Name *This question is required.

2. Pharmacy *This question is required.

3. Street Address *This question is required.

4. City, State, Zip *This question is required.

5. Telephone # *This question is required.

6. Email *This question is required. This question requires a valid email address.

7. NCPA Member # This question requires a valid number format.

8. Are you currently or do you plan to provide COVID-19 vaccinations? *This question is required.

9. Would you be interested in pharmacy student support to provide COVID-19 vaccinations? *This question is required.