Proposal to the Board of Directors Form
Please complete all questions.
Name
*
First Name
Last Name
E-mail
*
Please check the office for which you are being nominated
*
President-Elect
Board of Directors
Active Pharmacist
Associate Member
Student Member
Technician Member
Pharmacy Resident
BUSINESS Phone Number
*
MOBILE PHONE Number
*
what is the proposal? desCRIBE THE WHO, WHAT, AND WHEN IN ONE SENTENCE EACH.
*
Include names of employers in reverse chronological order for past 10 years
WHAT ARE FACTS REGARDING THE PROPOSED TOPIC OR ACTIVITY? PROS & CONS? BE ACCURATE, BE SPECIFIC, PROVIDE NUMBERS WHERE APPLICABLE.
*
Title and scope of duties
WHERE DOES THE PROPOSAL LINK TO THE ORGANIZATION'S STRATEGIC PLAN, MISSION, AND VISION? BE SPECIFIC, BE BRIEF.
*
List degrees or certificates and granting institution only
WHAT WILL BE DIFFERENT ONCE STARTED OR COMPLETED? BE SPECIFIC, BRIEF.
*
List most recent first
WHAT WILL BE THE MEASURES OF SUCCESS OR CHANGE?
*
List roles, titles, position, etc.
WHAT DO YOU WANT THE BOARD OF DIRECTORS TO DO?
*
To date
WHO WILL DO WHAT NEEDS TO BE DONE? HOW WILl IT BE DONE?
*
State, local, national, etc
WHAT FINANCIAL RESOURCES ARE NEEDED? ESTIMATED DOLLAR AMOUNT?
*
State, local, national, etc
WAS THE TREASURER CONSULTED REGARDING MONEY INVOLVED?
YES
NO
WERE OTHER OFFICERS CONSULTED REGARDING RESOURCES?
YES
NO
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