NCPA Foundation COVID-19 Vaccination Administration Student Survey

The NCPA Foundation is seeking to identify pharmacy students to help community pharmacists with their COVID-19 vaccination efforts. If you are a pharmacy student interested in volunteering with a pharmacy, please complete the short survey below. Filling out this survey does not commit you to participating and it does not guarantee that you will be contacted by a pharmacy.

1. First and Last Name *This question is required.

2. Current Address (Street Address, City, State, Zip Code) *This question is required.

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

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

5. Phone number *This question is required.

6. Will you be at a different address over the summer? *This question is required.

Please enter an 'other' value for this selection.

7. How many hours per week could you commit to assisting with COVID-19 vaccine administration? *This question is required.

8. How many miles are you willing to travel? *This question is required.

9. When are you available to start? *This question is required.

10. Have you completed a Pharmacy-Based Immunization Administration course? *This question is required.

11. Please provide any additional information you think might be helpful.