Resident/Fellow of Distinction Award

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Resident/Fellow of Distinction Award The California Society of Health-System Pharmacists’ Resident/Fellow Distinction Award is designated to recognize an exemplary post-graduate resident or fellow, who has made significant contributions to his/her local chapter and has promoted CSHP’s Mission: To promote wellness, patient safety and optimal use of medication: (a) Serving as an organization through which the membership pursues its common professional goals. (b) Providing leadership for the profession and support for its members. (c) Advocating for its members before private and public agencies and health care professional organizations. The Society believes members promote and sustain CSHP’s mission by sharing innovations and model practices with others through publication, formal presentations and by mentoring or serving as a preceptor. Each candidate must meet or exceed each of the following criteria in order to be eligible for this award: 1. Active new practitioner member (NPY1-NPY5) of CSHP currently enrolled in a post- graduate residency or fellowship o Not a current director, elected officer, paid employee, New Practitioner Executive Committee member of CSHP 2. Active participation in regional CSHP chapter activities o Consider the following activities: (a) an elected position of local CSHP chapter; (b) member of a committee, task force, or ad hoc group established by regional CSHP chapter; and/or (c) attendance and active involvement at meetings of regional CSHP chapter APPLICATION Resident/Fellow Distinction Award Instructions: To be completed by an active member of CSHP on behalf of the candidate. Please type or print all information. Fill out the application form completely. A curriculum vitae may be attached, but attachment of a curriculum vitae and reference to applicable sections shall not be acceptable as a substitute. An incompletely filled out application form shall serve as the basis for denial of an application. Provide one (1) letter of support from a CSHP member, attesting to the active involvement in a regional CSHP chapter o Letters of recommendation may not be submitted by any current member of the New Practitioner Executive Committee or by CSHP’s Executive Vice President. o Letters of recommendation must come from a current CSHP member. To this completed application attach the letter of support and submit via the CSHP Website at: www.cshp.org/ResidentFellowAward Application Deadline: July 1 Candidates and nominator will receive the results of their application in early August. APPLICATION/NOMINATION FORM Resident/Fellow Distinction Award I. Contact Information Candidate’s Name (Include Credentials) Residence Address City State Zip Home telephone Residency/Fellowship Program Business Address City State Zip Work telephone Email address Preferred Address for Correspondence: Home Work Nominator’s Name Address City State Zip Telephone Email address II. Activities in Professional Organizations Participation in CSHP activities at the regional level Year CSHP Regional Chapter Position/Activity .

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