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Nomination for
Innovative Pharmacy Practice Award

The Innovative Pharmacy Practice Award may be awarded at the PSW Annual Meeting The award, which is a national award sponsored by Elan Pharmaceuticals, is granted to recognize and honor a qualified Wisconsin pharmacist who has demonstrated significant innovation in their respective practice.

SELECTION CRITERIA
Demonstration of innovative pharmacy practice, method or service directly or indirectly resulting in improved patient care and/or advancement of the profession of pharmacy.

Past PSW Recipients
2010 Jeff Kirchner
2009 Charlotte Smith
2008 Lee Vermeulen
2007 Ken Ford
2006 Mike Flint
2005 Patrick Cory
2004 Ed Heckman

2003 None
2002 Rebecca Marnocha
2001 John Waclawski
2000 Terry Maves

1999 Wallace Simons

1998 Chris Sorkness

Past WPhA Recipients
1997 Mike Boushon

1996 Brian Jensen
1995 Tom Thielke
1994 Ralph Kalies
1993 John Bohlman

AWARD ELIGIBILITY
Any licensed pharmacist practicing and residing in Wisconsin who is not a member of the PSW Board of Directors, an elected officer or a paid employee of PSW and whose current membership in PSW is in good standing.

AWARD DESCRIPTION
Recipient of this award shall receive a limited edition, framed print and specially designed medallion from Elan Pharmaceuticals. In addition, recipients will receive recognition in JPSW and at the Annual Awards Banquet.

NOMINATION COMPLETION AND SUBMISSION
All nominations must be fully completed and submitted to PSW by the nomination deadline in order for the nominee to be considered as a candidate for the award.  All incomplete nominations will be returned to the nominator for re-submission.  Nominations postmarked or date stamped after the nomination deadline will not qualify for consideration until the following year. To complete the nomination, please submit three (3) letters in support of this candidate’s nomination by June 1st.  Each letter supporting nomination should be accompanied by writer’s name, work site and contact information.  One letter of support can be written by the award candidate.  In addition, a curriculum vitae or resume may be substituted in place of one letter of support.  Each qualified nomination will be evaluated based on the award’s selection criteria. Documentation supporting candidate’s nomination should highlight how candidate has fulfilled the awards selection criteria. For questions or for more information, please contact the PSW office at (608)- 827-9200.

You may Email your nomination to Dawn Fargen.

Include:

Candidate’s Name
Worksite
Address

City
State
Zip
Business telephone
E-mail
Home phone

Nominator’s name is a required element of a complete nomination.  If nominator’s name is the same as candidate’s name, please indicate.

Nominator’s Name
Worksite
Address
City
State
Zip
Business telephone
E-mail
Home phone

Email: Sarah Sorum

Pharmacy Society of Wisconsin
701 Heartland Trail - Madison, WI 53717
Telephone: (608) 827-9200 - Fax: (608) 827-9292