Bowl of Hygeia



Nomination Form: Pfizer Consumer Healthcare Bowl of Hygeia
 
 
DESCRIPTION
The Bowl of Hygeia is awarded annually to a pharmacist who has compiled an outstanding record of community service which, apart from his/her specific identification as a pharmacist, reflects well on the profession. For more details, see the terms of reference.
 
INSTRUCTIONS
All sections of this form should be completed to the fullest, as candidate selection depends on the information presented here.
 
HOW TO CREATE A SUCCESSFUL AWARD NOMINATION

The APEX (Alberta Pharmacy Excellence) Awards recognize excellence in pharmacy practice in Alberta. The awards are jointly funded, promoted and presented by the Alberta College of Pharmacists and the Alberta Pharmacists’ Association.

Applications are judged solely on the information provide on the nomination form. The Awards Committee will not conduct any investigation on behalf of the candidates. To ensure applications are as complete as possible, nominators should pay particular attention to the suggestions listed below and should go to https://pharmacists.ab.ca/nAboutACP/APEXAwards.aspx to see previous award winners and read about their achievements that qualified them to be award recipients.

How do I prepare my nomination?
First, read the award’s terms of reference to ensure your nominee is eligible for the award. Then, answer each question on the nomination form as fully as possible. Consider describing:
·         the value your nominee provides to patients, co-workers, their community,
          other health professionals, etc.
·         how the nominee implemented and executed their initiatives.
·         patients’ reactions - include any patients’ expectations, problems, solutions and 
          outcomes.
·         any unique strategies your nominee used.

How might I answer “Is there anything more about this nominee you would like us to know”?
Consider including supporting information with your nomination. Work with patients, colleagues and other health professionals to enhance your entry. This can include gathering:
·         testimonials from patients, colleagues, professors, and faculty
·         testimonials from heads of organizations and associations
·         personal background information on the nominee
·         copies of any promotional materials that have been prepared
·         records of achievement or other recognition

What makes a good entry?
Compelling entries:
·         are thorough, with a clear description of the initiative or work completed.
·         provide solutions that are patient-centred.
·         show the nominee’s strong dedication to the initiative or work completed as
          well as to the larger profession.
·         demonstrate that the nominee went beyond the call of duty and consistently
          strove for excellence.
·         Are supported by material from a variety of sources (e.g., patient testimonies,
          newspaper and magazine articles).

 
SUBMISSION INFORMATION
Please submit your nomination to Sheena McNally, ACP Communications Coordinator, by:

Pressing the SUBMIT button below OR Printing the nomination form and faxing it to 780-990-0328.


NOMINEE INFORMATION

* indicates a mandatory field

* Surname:  
* Given Name(s):  
  Home Address:  
* Employer:  
* Employer Address:  
* Present Occupation / Title / Responsibility:  
* Daytime Phone: () ex. (780) 444-5555  
  Evening Phone: () ex. (780) 444-5555  
  Fax: () ex. (780) 444-5555  
  Email Address:  
  University Degree:
 
  Other Honors / Distinctions:


REASON FOR NOMINATION


Please give details for each of the following questions. Nominators should provide the fullest possible details of the nature and quality of the nominee's activities. Include specifics about years of involvement, leadership roles, and accomplishments, rather than general testimonials.

1. What makes this nominee a professional role model?
 
2. What civic and/or government organizations has this nominee been involved with?
 
3. What community activities has this nominee been involved with?
 
4. What pharmaceutical organizations does this nominee belong to?
 
5. How does this nominee promote the profession of pharmacy?
 
6. Is there any additional information about this nominee you would like us to know?
 


NOMINATOR & SECONDER INFORMATION

We have prepared this nomination and, based on the information contained here, we recommend that (NAME OF NOMINEE) be awarded the Pfizer Consumer Healthcare Bowl of Hygeia. This nomination is based on the information known to us and, to the best of our knowledge, is complete and accurate.
 
Nominated By:
* Name (full):  
* Daytime Phone: () ex. (780) 444-5555  
* Email:    
* Relationship to Nominee:  
* I have known the nominee for years.    
 
Seconded By:
* Name (full):  
* Daytime Phone: () ex. (780) 444-5555  
* Email:    
* Relationship to Nominee:  
* I have known the nominee for years.    


ADDITIONAL INFORMATION

Questions?
Please contact Sheena McNally, ACP Communications Coordinator, at communications@pharmacists.ab.ca if you require an explanation of the criteria or process.
 
Submission Information
Please submit your nomination to Sheena McNally, ACP Communications Coordinator, by:

Pressing the SUBMIT button below
OR
Printing the nomination form and faxing it to 780-990-0328.