Application - Hospital Pharmacy Student Award

Nomination Form: CSHP-CAPSI Student Award

Submission deadline: October 31(23:59 Pacific Time)
Eligibility
This award is for student pharmacists who are members of both the Canadian Society of Healthcare-Systems Pharmacy (CSHP) and the Canadian Association of Pharmacy Students and Interns (CAPSI) and are currently enrolled in a Canadian undergraduate pharmacy program. Only one award is given annually, and it will not be granted if there are no qualified candidates.

About the award
The recipient will be recognized at either CAPSI’s Professional Development Week (PDW) or CSHP’s Professional Practice Conference (PPC) and will receive a certificate, complimentary conference registration, and coverage for travel and accommodation.

Application Form
There are five steps to filling out this application. For the submission to be considered, every step needs to be finished. You may save your nomination and continue later. Unfinished nominations at submission deadline will not be taken into account.
Step 1: Contact information
You may nominate yourself or someone else for this award. To nominate a student, please complete Sections A & B. If this is a self-nomination, continue to Section B.
- Name of nominator
- CSHP # (if applicable)
- CSHP # (if applicable)
- Organization
- Job title
- Phone number
  
  Area CodePhone Number
- Email
  example@example.com
- Relationship to nominee
- I have received the nominee's consent
- Name of applicant/nominee
- CSHP #
- Phone number
  
  Area CodePhone Number
- Email
  example@example.com
- Pharmacy school
- The candidate is enrolled with both CSHP and CAPSI
- Step 2. Questions
- a. 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 (10 points):
  
  0/300
- b. Outline the candidate’s volunteer work and describe its impact on their future practice. Consideration will be given to experience in patient care, education, and research. Include volunteer work with CSHP and CAPSI in Section e, below (10 points):
  
  0/300
- c. What makes the student is an ideal candidate for this award (20 points)?
  
  0/300
- d. The candidate has shown a commitment to hospital pharmacy practice through participation in the education of healthcare practitioners, the public, or patients.
  
  Provide the following information related to the candidate’s pharmacy-related publications and presentations (exclude entries related to course work or practicums). For each activity, please include the following information:
  - Type: abstract, newsletter, poster, presentation, and publication
  - Full author citation
  - Status: presented, published, or in-progress
  - Date
  - Audience
- PROJECT # 1 Type (select all that apply):
  
  Other
- Project title:
- Full author citation:
- Date:
- Audience:
- Project status (choose one):
- PROJECT # 2 Type (select all that apply):
- Project title:
- Full author citation:
- Date:
- Audience:
- Project status (choose one):
- PROJECT # 3 Type (select all that apply):
- Project title:
- Full author citation:
- Date:
- Audience:
- Project status (choose one):
- PROJECT # 4 Type (select all that apply):
- Project title:
- Full author citation:
- Date:
- Audience:
- Project status (choose one):
- PROJECT # 5 Type (select all that apply):
- Project title:
- Full author citation:
- Date:
- Audience:
- Project status (choose one):
- Please include all entries if you have more than five. Please input the following details for each activity using the layout above as a guide: Type, Title, Full author citation, Date, Audience, and Status
- e. 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. For each experience, please provide the following information:
  - Organization: CSHP or CAPSI
  - Level: national, branch/provincial, or chapter/local
  - Position
  - Dates
  - Duties performed
- ACTIVITY # 1: Organization and level
- Position
- Start date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- End date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Are currently in the role?
- Duties performed
- ACTIVITY # 2: Organization and level
- Position name
- Start date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- End date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Are currently in the role?
- Duties performed
- ACTIVITY # 3: Organization and level
- Position
- Start date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- End date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Are currently in the role?
- Duties performed
- ACTIVITY # 4: Organization and level
- Position
- Start date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- End date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Are currently in the role?
- Duties performed
- ACTIVITY # 5: Organization and level
- Position
- Start date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- End date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Are currently in the role?
- Duties performed
- Please include all activities if you have more than five. Please input the following details for each activity using the layout above as a guide: Organization/Level, Position, Dates, and Duties performed
- Step 3. Preceptor information
- The candidate must be endorsed by their preceptor or supervisor. If the preceptor or supervisor is not a CSHP member, an additional endorsement from a CSHP Member or Individual Supporter is required.
- Name of Preceptor
- CSHP # (if applicable)
  Additional requirement: If the preceptor or supervisor is not a CSHP member, please include the name of a CSHP Member or Individual Supporter in good standing who can confirm the candidate’s involvement with CSHP.
- Name of CSHP Member/Supporter
- CSHP #
  Good standing = dues paid through June 30, 2027
- Step 4. Letter of recommendation
- A letter of recommendation (not exceeding 500 words) from the candidate’s preceptor or supervisor must be submitted. The letter should endorse the candidate and demonstrate their suitability based on the award’s purpose and criteria. Note: The preceptor or supervisor does not need to be a member of CSHP.
- Upload a letter of recommendation
  
  Browse Files
  
  Cancelof
- Step 5. Provide supporting documentation
- A copy of the candidate’s curriculum vitae (maximum two pages) must be submitted. The CV should include an overview of the candidate’s CSHP and CAPSI activities.
- Upload a CV
  
  Browse Files
  
  Cancelof
- Award details
  Award submissions will be adjudicated by the CSHP National Awards Committee (in consultation with CAPSI). Assessment will be based solely on the information provided. In the event of a peer-nomination, additional details may be requested by the Awards Committee.
  - Submissions due by October 31 (23:59 Pacific Time)
  - Winner contacted in November
  - Winner announced in January via website, email, and social media
- Submission Checklist:
- Please verify that you are human
- Thank you!
  
  For taking the time to complete this nomination. If you would like more information, please contact Robyn Rockwell, Membership and Awards Administrator, at rrockwell@cshp.ca or (613) 909-9964.
- Should be Empty:

Nomination Form: CSHP-CAPSI Student Award

Step 1: Contact information

Step 2. Questions

Step 3. Preceptor information

Step 4. Letter of recommendation

Step 5. Provide supporting documentation