OSHP Residency Program Director Award
To recognize a pharmacist who has demonstrated excellence in the position of Residency Program Director.
Nominee Information
Nominee Name
First Name
Last Name
Nominee Email Address
*
example@example.com
Nominee Phone
*
-
Area Code
Phone Number
How many years has this nominee been a Residency Program Coordinator or Director. Please specify number of years and role.
How many residents has the nominee precepted over the past 5 years (i.e. PGY1/PGY2 residents, other professions)?
Please describe how the nominee contributed to the initiation of a new residency program or how has the nominee successfully expanded the number of existing residency applications within a program or how has the nominee expanded offerings/educational opportunities at the residency location in the last 5 years. Please provide specific examples.
Please describe the nominees advocacy and teaching innovation over the past 5 years. Examples include: Participation in a residency information panel, presenting on the subject of residencies at a state or national conference, committee/taskforce involving a residency program, other residency advocacy activities.
Define any teaching-related awards received by the nominee at the local, state, or national level within the last 5 years.
List OSHP involvement over the last 2 years. This could include membership on a specific division, volunteer efforts, etc. This does not include only OSHP membership.
Please list the years the nominee has been a member of OSHP.
Nominator Information
Nominator Name
*
Nominator Employer
*
Nominator Phone
*
-
Area Code
Phone Number
Nominator Email Address
*
example@example.com
By checking below, I hereby: Attest that all information I have provided in conjunction with this application is true and completed by myself as the nominator. Attest that this individual is of upmost ethical and professional standing. Acknowledge and agree that if during the application process, I make any false or misleading statements—including material omission—that this may be considered grounds for removal of the application from award consideration.
*
I have read and agree with the above statement.
Attachment(s)
Letter of support for current/past resident (within last 3 years)
*
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