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    2016 Steven G. Avey Award

    Deadline August 28, 2015 

      Please send the CV/Résumé to Ebony Clay at eclay@amcp.org.    

     

    *Denotes a required field 

     

    Nominee Information  

    *Name:
     

    Title: 
     

    Company: 
     

    *Address 1:
     

    Address 2:
                              : 

    * City: 

     

    *State: 
     

    *Zip: 
     

    *Phone Number: 
     

    Fax Number: 
     

    *Email: 
     


     

    Nominated by 

    *Name: 
     

    Company: 
     

    *Phone Number: 
     

    *Email: 
     


     

    Nomination supported by the following AMCP Members or Non-Members 

    First Supporter 

    *Name: 
     

    Company: 
     

    *Phone Number: 
     

    *Email:

     

    Second Supporter 

    *Name: 
     

    Company: 
     

    *Phone Number: 
     

    *Email: 
     

     

    Third Supporter 

    *Name: 
     

    Company: 
     

    *Phone Number: 
     

    *Email: 
     

     

    Fourth Supporter 

    *Name: 
     

    Company: 
     

    *Phone Number: 
     

    *Email: 
     

     

    Fifth Supporter 

    *Name: 
     

    Company: 
     

    *Phone Number: 
     

    *Email: 
     

      

    NOMINEE BACKGROUND INFORMATION 

    The nominator must submit a statement of 500 words or less describing why the candidate should be the recipient of the Steven G. Avey Award, and how this candidate’s accomplishments warrant being recognized as distinguished contributions to managed care pharmacy. 

    The nominee’s CV or résumé must be submitted via email to Ebony Clay, eclay@amcp.org.  


    Significant and Sustained Leadership Contributions:
     

    1. Describe outstanding accomplishments that the candidate contributed and how they made distinguished contributions managed care pharmacy.
    2. What professional organization activity has the candidate been involved with? Please provide specific information regarding the nominee's service in elected office/years; committee appointments/years; or other activities (including, but not limited to, task forces, membership programs, speaking engagements, publications, etc.) Cite how these activities advanced managed care pharmacy practice.
    3. List honors/awards the candidate has received and describe the purpose of the honor/award, and sponsoring organization.
    4. List community service projects the candidate has led or participated in that demonstrate leadership and commitment to community values.
    5. Additional Comments



     

     

    * 500 words or less describing why the candidate should be the recipient of the Steven G. Avey Award