APhA Immunization Champion Awards 2015 Nomination Form

The 2015 APhA Immunization Champion Awards recognize individuals and organizations within the profession of pharmacy that have made extraordinary contributions towards improved vaccination rates within their communities.  There are six (6) categories of recognition including individual practitioners, corporations / institution, partnerships with other healthcare providers and public health, community outreach, a special friend of pharmacy’s immunization efforts and a pharmacy team member . The awards will be presented at the APhA Annual Meeting, March 27-30, 2015, San Diego, CA
. Nomination forms must be received by close of business on November 14, 2014. 

Award Information

Award Categories: The six (6) categories of recognition include:
  • Individual Practitioners: pharmacists
  • Corporations / Institutions: community pharmacies, hospital pharmacies, long-term care pharmacies, clinics, etc.
  • Partnerships with other Health Care Providers and Public Health: collaborations between pharmacies/pharmacists and immunization coalitions, physicians, nurses, public health departments, etc to address an immunization issue and/or provision of immunization services
  • Community Outreach: activities conducted within your community to increase immunization awareness and delivery
  • Friend of Pharmacy: an individual who is a non-pharmacist and has supported, facilitated or advocated for pharmacists’ role in immunizations. Individuals could include a coalition leader, community leader, policy maker, physician, public health official, reporter, etc.
  • Pharmacy Team Member: an individual who is not a pharmacist nor a student pharmacist who has been an advocate for immunizations and who has proactively identified at-risk patients for vaccination. Individuals could include a pharmacy technician, store manager, store cashier, etc.

 

Evaluation Criteria: Nominees will be evaluated in the following areas related to their immunization activities:
  • Impact: How did their work support/utilize pharmacists to improve immunization rates, education or access?
  • Collaboration: Describe the extent of collaboration with other providers and/or organizations within their community or practice setting.  In particular, how has the nominee supported achievement of the "immunization neighborhood" ( Collaboration, coordination, and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases. )
  • Originality: Describe the creativity, innovation and originality utilized by the nominee in achieving increased vaccination rate, access and/or information within their community.
  • Challenges and Opportunities: Describe the challenges and opportunities that the nominee encountered and how they addressed those issues.
Each Award Category recipient receives:

National Winner

  • Travel to San Diego, CA (coach airfare up to pre-determined amount)
  • Lodging (up to 2 nights)
  • Annual Meeting Registration
  • Honorarium of $500
  • Award Crystal
  • Opportunity to deliver up to 2 minute remarks at the Awards reception

 

Honorable Mention

  • Annual Meeting Registration
  • Honorarium of $100
  • Award Plaque
  • Opportunity to deliver up to 2 minute remarks at the Awards reception

 

Nominations may be submitted online by completing the form below and clicking the submit button.

Direct inquiries or mail, fax or email completed forms to:

Monica Ostrander
c/o American Pharmacists Association
2215 Constitution Ave, NW
Washington, DC 20037
1-800-237-APhA (2742) ext 7515 Direct: 202-429-7515 FAX: 202-783-2351
email:
mostrander@aphanet.org

Nominee

 What type of practice setting is the nominee in:
 Is the nominee an active member of APhA?

Individual Submitting Nominations

Self Nomination? 

For nominees who administered vaccines, indicate the number of vaccines administered by the nominee or pharmacists within organization since January 2014  (not required information but enhances application): 
 Number of vaccines
Influenza
Pneumococcal
Zoster
Tetanus
HPV
Hepatitis A
Hepatitis B
Other
 Indicates Response Required