Willard B. Simmons Independent Pharmacist of the Year Award

The NCPA Willard B. Simmons Independent Pharmacist of the Year Award recognizes an independent pharmacist for exceptional leadership and commitment to independent pharmacy and the community.

The winner of this award will receive an engraved commemorative plaque, a $1,000 cash award, travel expenses to NCPA’s 124 th Annual Convention, October 1-4, 2022 in Kansas City, MO. Accommodations for up to three nights, coach airfare for recipient, $1,000 to the school/college of pharmacy of choice designated by the award recipient, and a complimentary convention registration for recipient and guest.

Candidates for the NCPA Willard B. Simmons Independent Pharmacist of the Year Award must be an NCPA member and an owner or manager of an independent pharmacy. Self-nominations are acceptable.

The award bears the name of Willard B. Simmons of Chicago, Illinois, a long-time NCPA Foundation board member and retired NCPA executive secretary who exemplified outstanding leadership and commitment to independent pharmacy during his long career.

ALL NOMINATIONS MUST BE SUBMITTED BY July 13, 2022

1. Nominee Information *This question is required.

Nominee

Home Address

City

State

Zip

Pharmacy

Email Address This question requires a valid email address.

Nominee's Professional Degrees:

B.S./Where obtained:

B.S./Year:

Pharm.D/Where obtained

Pharm.D/Year

M.S./Where obtained

M.S./Year

Ph.D./Where obtained

Ph.D./Year

Other/Where Obtained

Other/Year

PROFESSIONAL SERVICE

Offices Held
Please list below any offices held in NCPA and/or in state or local professional organizations.

Committee Service
Please list below national, state, or local committee appointments held; length of service, and name of the professional organization.

Community Activities
Outline any civic activities in which the nominee has been or is currently involved.

Supporting Data
The nominee should have contributed significantly and consistently to advancement and recognition of independent pharmacy. Please indicate any programs and activities in which the nominee is directly involved that have benefited independent pharmacy. Press clippings, photos, etc. may be attached to this application. Any written attachments should not exceed two pages.

Supporting Documents
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Submitted by (Nominator):

FirstName

Last Name

Street Address

City

State

Zip

Email Address

Relation to Nominee