Award nomination form

Use this form to submit your award nomination for PSA State and Territory awards.

 

Nominations will be taken for Pharmacist of the Year, Early Career Pharmacist of the Year, Lifetime Achievement Award and Intern Pharmacist of the year for all states and territories (excluding Tasmania who take part in the combined Tasmanian Pharmacists Awards)

 

To be eligible to receive a state and territory award, a nominee must be a PSA member, and have exemplified a contribution to the profession that aligns with one of PSA’s 11 Action Items For Change.

 

Nominations close Monday 9 November 2020.

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Nominee Details














Nominated by












Page 2

Award details

Intern Award details


Please provide the contact details of up to two referees who support this nomination















doc, docx or PDF format
Award details (cont)

Which Award category are you nominating for? You may select more than one. 

(CTRL click to select multiple awards)










Nomination Details