2020 Indiana Pharmacists Association Annual Awards Nomination Form

Nominations will be accepted through Saturday, August 15, 2020

Award descriptions are available here. All nominees must be current active IPA members. Award recipients will be presented with their award during the IPA Annual Convention on October 27, 2020. Please contact Stacy Allgeier at stacy@indianapharmacists.org if you have additional questions. We thank you for your nomination!

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* 1. Please indicate the award this nomination form is intended for:

Bowl of Hygeia (Sponsored by APhA Foundation and NASPA)

Excellence in Innovation

Joseph E. McSoley Pharmacists of the Year (presented by IACP)

Glen Sperandio Health-System Pharmacist of the Year (presented by ISHP)

Beyond Dispensing (presented by IANTP)

Donald L. Moore Independent Pharmacist of the Year (presented by IAIP)

Distinguished Young Pharmacist (Sponsored by Pharmacists Mutual Insurance Companies)

Outstanding Student of the Year

Pharmacy Technician of the Year

Organizational Medication Safety Award

Individual Medication Safety Award

Jeremy Thain Pharmacist Mentor of the Year (presented by IASP)

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* 2. Please fill out the following information as it pertains to the Nominee.

Name

Email Address *

Phone Number *

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* 3. Please provide information for the nominee's employer so they can be notified if nominee wins award.

Contact Name

Company *

Email Address *

Phone Number *

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* 4. Please provide the following information about yourself, the Nominator.

Name

Email Address

Phone Number

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* 5. Is the nominee aware of your nomination?

Yes

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* 1. Please indicate the award this nomination form is intended for:

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* 2. Please fill out the following information as it pertains to the Nominee.

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* 3. Please provide information for the nominee's employer so they can be notified if nominee wins award.

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* 4. Please provide the following information about yourself, the Nominator.

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* 5. Is the nominee aware of your nomination?

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* 6. Nominator, please provide detailed examples supporting the Nominee's contributions justifying receipt of the selected award.