Hospital Pharmacy Student Award Application

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Application instructions

If you are logged in to the CSHP website, you will be able to save a draft of your submission and come back later if needed. However, it is highly recommended that you try to submit your nomination in one session if possible.

Nominations and supporting documents will be accepted until September 30, 2020 (23:59 Pacific Time).

Section 1: Nominator information
If you are nominating a student for this award, please obtain their consent in advance, and complete Sections 1 and 2. Students who are self-nominating may skip to Section 2, below.
Name of nominator *
Section 2: Applicant/Nominee information
Name of applicant/nominee *
Section 3: Work experience
Describe how the candidate's work experience in an organized healthcare setting has prepared them for future practice? Consideration will be given to  experience in patient care, education, and research. 
 
Provide details below (300 words or less):
Section 4: Volunteer experience
Outline the candidate's volunteer work and describe its impact on future practice. Consideration will be given to experience in patient care, education, and research. Relevant volunteer work with CSHP and CAPSI can be included here if it does not apply to Section 6, below.   
Provide details below (300 words or less):
Section 5: Publications and presentations

The candidate has shown a commitment to hospital pharmacy practice through participation in the education of healthcare practitioners, the public, or patients.

Describe the candidate's pharmacy-related publications and presentations in the section below (exclude entries related to course work or practicums).  

If you wish to include more than eight pharmacy-related publications and presentations, you may do so here. For each entry, include (a) type (e.g., abstract, newsletter, poster, presentation, or publication), (b) status (e.g., presented, published, or in-progress) (c) title, (d) full author citation, (e) date, and (f) audience:
 
Section 6: Involvement with CSHP and CAPSI

The candidate has shown commitment to hospital pharmacy practice through voluntary participation in CSHP and CAPSI activities.

Describe the candidate's service to CSHP and CAPSI in terms of offices held and participation on committees, task forces, and working groups:

If yes, list positions held and length of service (e.g., mm/yyyy to mm/yyyy):
 
If yes, list positions held and length of service (e.g., mm/yyyy to mm/yyyy):
If yes, provide details below. For each entry, include (a) name of the committee or task force, (b) position held, (c) whether the position was at the national, branch, or chapter level, and (d) length of service (e.g., mm/yyyy to mm/yyyy):
 
If yes, list positions held and length of service (e.g., mm/yyyy to mm/yyyy): 
 
If yes, list positions held and length of service (e.g., mm/yyyy to mm/yyyy):
If yes, list positions held and length of service (e.g., mm/yyyy to mm/yyyy):
If yes, provide details below. For each entry, include (a) name of the committee, task force, or working group, (b) position held, and (c) length of service (e.g., mm/yyyy to mm/yyyy):
 
Section 7: What makes the applicant an ideal candidate for this award?
Provide details below (300 words or less):