Walter M. Frazier Award Nomination Form

The OSHP Walter Frazier Award

To recognize an individual who has demonstrated sustained exemplary service in the health-system pharmacy setting.
Nominee Information
Nominee Name

First NameLast Name
Nominee Phone Number

Area CodePhone Number
Nominee Current Employer (if applicable)
Nominee Email Address
example@example.com
Employer’s Address (if applicable)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Professional Title (if applicable)
Nominee Education and Training
Institutions attended, location, dates of graduation, type of training or major subjects, degrees, residencies, fellowships, certificates, major seminars attended, additional training.
Nominee Honors and Awards
Name of award, presenter, description, and date/year presented.
Nominee Work Experience
Professional and Related Experience: (institutions or organizations, locations, dates, type of work or position title.)
Nominee Professional Engagement
Institutional and/or Professional Organization committee work, or other related experience and involvement.
Nominee Significant OSHP Contributions
Other Nominee Significant Contributions
Signiﬁcant Contributions to Profession/Institutions
Additional Significant Information
Any additional information you would like the selection committee to be aware of
Nominator Information
Nominator Name(Individual or Institution)
Nominator Current Employer
Employer/Institution Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominator Phone Number

Area CodePhone Number
Nominator Email Address
example@example.com
Additional Nominator Name(s) and Information (if applicable)
Attachments
Nominee’s CV (Required)

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Additional Evidence #1

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Additional Evidence #2

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Additional Evidence #3

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Please note that you will NOT receive an email confirming your submission, but you should see an on-screen confirmation.
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The OSHP Walter Frazier Award