By completing and submitting this form, you are indicating to your colleagues that you wish to be considered for leadership opportunities within the California Pharmacists Association. The deadline to submit applications is April 20, 2021 at 11:59 pm.

Information submitted will be reviewed by the Nominating Committee and utilized to determine the best candidates for elected positions within the California Pharmacists Association.  We encourage all applicants to review the CPhA Strategic Plan as a guide to the organizations' vision.
 
With this form, you can submit an application for:
  • President-Elect: Requires a three year commitment, one year as President-Elect, one year as President, and one year as Past President
    Speaker-Elect: Requires a two year commitment, one year as Speaker-Elect, one year as Speaker (voted on at House of Delegates)
    Trustees: Three year term
    Treasurer: Two year term
    SIG Chair-Elect: Requires a two year commitment, one year as Chair-Elect, and one year as Chair. 
  • APhA House of Delegates
  • NCPA House of Delegates

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* 1. Please tell us who you are and how to contact you.

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* 2. Select your CPhA membership category.

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* 3. Which CPhA Local Chapter(s) are you affiliated with?

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* 4. What is your primary pharmacy practice setting(s)?

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* 5. Please rank the elected position(s)that most interest you.  

  No interest Somewhat interested Neutral Very interested Extremely interested
President (3-year commitment as President-Elect, President, Immediate Past President)
Treasurer (2-year term)
Trustee (3-year term)
Speaker elect (1-year term as elect, 1 -year term as Speaker)
Student Trustee (1-year term)
APhA Delegate
NCPA Delegate

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* 6. For those seeking to serve as Chair Elect of a Special Interest Group(SIG) please rank the SIG(s) you wish to be considered for.  For a description of our SIGs, please click here.

  No interest Somewhat interested Neutral Very interested Extremely intested
Ambulatory Care
Community Pharmacy
Compounding
Inpatient
Long Term Care
Managed Care
Pharmacy Ownership
Pharmacy Technician

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* 7. For those seeking to serve as a Delegate to APhA or NCPA, have you served as a delegate before as a representative of CPhA?

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* 8. If you answered "Yes" to question 6 what delegations were you a part of and when did you serve?

The next few questions will provide the Nominating Committee information about you!  Please feel free to provide examples, perspective and any information that can be used to provide the reason for your wishing to serve as a leader in CPhA.

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* 9. Please list your prior appointed and elected positions you have held with CPhA and other pharmacy related associations.

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* 10. What other leadership and/or volunteer experience do you have that would be valuable in the position(s) you are seeking?

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