APhA Foundation Board of Directors

Call for Nominations

2016-2019 Term of Office

The APhA Foundation Committee on Nominations requests that the following form be completed and electronically submitted with your résumé/CV and photo (headshot). Please complete the form in its entirety and do not reference areas in your résumé/CV. These materials must be RECEIVED by the Committee NO LATER THAN Friday, August 21, 2015.

Before submitting your name for nomination, carefully review and consider the qualifications, position duties and responsibilities, conflict of interest statement, and time commitment for the offices outlined in the Call for Nominations booklet.

If you have any questions or need assistance with this form, please contact Brian Donahue at (202) 429-7503 or bdonahue@aphanet.org.

Nominee Information
Address Type *
PLEASE ENSURE THE FOLLOWING INFORMATION IS PROVIDED IN YOUR RÉSUMÉ/CV:

1. Education information, including academic institutions attended, degree(s) earned and year(s). Please include any other training that will benefit the Foundation.

2. Present employment – Professional position or title and organization.

3. Previous employment (Last 3).

4. Other pharmacy or scientific organization memberships (national, state, or local).

5. Offices you have held in local, state, or national pharmacy or scientific associations.

6. Offices you have held in health care-related organizations or foundations.

7. Honors or awards you have received.



PLEASE PROVIDE THE FOLLOWING INFORMATION.
3. You are required to answer the following two questions. Your response to each question must be no longer than 200 words.
0/200 words
0/200 words
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