NCPA Foundation Past Disaster Relief Grant Recipients

Have you received a disaster relief grant from the NCPA Foundation? We’d love to hear from you! Please complete the brief survey below. By answering these questions, you give permission to the NCPA Foundation to use your responses in aggregate or identified by First Name and Last Initial for program analysis and promotion.

1. Pharmacy Name *This question is required.

2. City, State *This question is required.

3. Name of person completing survey. *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. Are you a current NCPA member? *This question is required.

7. Enter your NCPA Member ID, if known.

7. Briefly describe the situation that led to your request for a disaster relief grant from the NCPA Foundation. *This question is required.

8. What month/year did you receive the funds, if known.

9. How did the NCPA Foundation grant funds help your pharmacy recover after the disaster? *This question is required.

10. Do you have any additional comments you would like to share?