NCPA Chapter Member Excellence Award

Students are not competing nationally for this recognition. Student should be nominated by either the faculty liaison or the chapter president. Each school can nominate one student from their chapter. All nominated students will receive a certificate and letter of congratulations. The certificate will be mailed to the NCPA Faculty Liaison and should be presented to the recipient at an appropriate ceremony. Submission of this form is due by FEBRUARY 28. Students nominated should have demonstrated excellent dedication to the NCPA student chapter through consistent engagement in the chapter meetings and events, holding an officer position or multiple positions, and being a positive role model and voice for independent community pharmacy. Please note, the NCPA chapter must be in good standing with at least 16 national dues paying members.

1. Nominated Student Name (first and last name) *This question is required.

2. Nominated Student NCPA Member ID (active membership will be verified) *This question is required.

3. Brief description of nominee's contributions to the chapter *This question is required.

4. School/College of Pharmacy *This question is required.

5. Name of Chapter Advisor/Faculty Liaison (first and last name) *This question is required.

6. Chapter Advisor/Faculty Email *This question is required. This question requires a valid email address.

7. Name of Nominator (first and last name)
*This question is required.

8. Nominator's Email *This question is required. This question requires a valid email address.

9. Mailing address for certificate (please include name, complete street address, city, state, zip code) *This question is required.