FPPAG Recognition Program Recommendation Form

The Fellow in Pediatric Pharmacy Advocacy Group (FPPAG) Program is intended to recognize excellence in pediatric pharmacy pratice and grant recognition to and promote awareness of pediatric pharmacists who have distinguished themselves.

As part of the application review process, it is critical that each candidate obtain a written assessment from colleagues concerning his or her contributions to pediatric pharmacy practice.

In order to fulfill this requirement, you have been asked to respond to the following questions as thoroughly as possible.

Please submit on or before December 31.

Candidate Information

First Name*

Last Name*

Recommender Information

First Name*

Last Name*

Address Information*

Telephone Number*

Email Address*

Candidates professional relationship with you*

How long have you known the candidate?*

Assessment

In your opinion, what are the candidate's significant contributions to pediatric pharmacy practice?*

Why do you believe the candidate has achieved a level of excellence in pediatric pharmacy practice?*

In your opinion, what has been the quality of the candidate's involvement in and commitment to educating practitioners and others?*

Additional Comments

Please include additional information about may assist the FPPAG Recognition Committee with their decision:

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