2009 Nomination Form

The American Pharmacists Association (APhA) is soliciting nominations for the 2009 APhA Immunization Champion Awards. The 2009 awards recognize individuals and organizations within the profession of pharmacy that have made extraordinary contributions towards improved vaccination rates within their communities. This awards program is supported by Novartis Vaccines and Diagnostics. The awards will be presented at the APhA Annual Meeting (April 5, 2009, San Antonio, TX from 5:30pm – 7:00pm). Nomination deadline is January 16, 2009.

Award Information

Award Categories: The five (5) 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.

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.
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:

Travel to San Antonio, TX (coach airfare up to pre-determined amount)
Lodging (up to 2 nights)
Annual Meeting Registration
Honorarium of $500
Award plaque
Opportunity to deliver up to 3 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:

Mitchel C. Rothholz, RPh, MBA
c/o American Pharmacists Association
1100 15th Street NW, Suite 400
Washington, DC 20005-1707
1-800-237-APhA (2742) ext 7549 Direct: 202-429-7549 FAX: 202-638-3793
email: mrothholz@aphanet.org

Nominee

Award Category Applying For:

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