HOPA 2021-2022 Board Election Application Form

Section 1: Candidate Application

Thank you for your dedication to HOPA and going through the candidate application process. Your service to the organization is greatly appreciated!

Please note that this application process will take you some time to complete. You should allow a minimum of 60 min to complete the form. The electronic application is divided into three sections: 1) Candidate Application (a series of questions to be answered by each candidate); 2) Conflict of Interest (any actual or perceived conflicts must be stated); 3) File Uploads (professional photo and CV). The information you provide will be used by the HOPA Nominations Subcommittee to identify a slate of well-qualified candidates for each open position on the Board of directors.

HOPA considers that well-qualified candidates:

Have a sincere interest in pursuing the board position. Have been an active participant in
HOPA.
Have specific goals for the advancement of HOPA that are important/significant and
related to the strategic plan.
Have an understanding of HOPA’s core purpose, values, and strategic plan. Are actively
involved in the practice of hematology/oncology pharmacy.
Have made significant contributions to oncology pharmacy practice.
Are recognized as leaders within the profession.
Have strong connections within the pharmacy and oncology communities.
Have strong organizational skills defined as the ability to provide oversight in aligning
resources to the association’s strategic direction.

Candidates may be interviewed by members of the Nominations Subcommittee to clarify qualifications.

Should you have any questions about the candidate application or nominations process, please send an email nominations@hoparx.org.

Note: Once you start the application process, please allow a minimum of 60 minutes to complete this form. You will not be able to save the information entered and return later for completion.

Question Title

* 1. Please provide your contact information:

Name

Current Employment / Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Indicate the type of nominations

Self nomination

Nominated by a colleague

Question Title

* 1. Please provide your contact information:

Question Title

* 2. Indicate the type of nominations

Question Title

* 3. Position for which you agree to be a candidate: