John F. (“Jack”) Schlegel Leadership Development Award NOMINATION FORM

      Welcome to the John F. (“Jack”) Schlegel Leadership Development Award nomination form.

      Each collegiate Chapter of ΦΔΧ may submit one nomination.

      The deadline for receiving nominations is May 25, 2023.

       

      The nominee should be a collegiate Brother of ΦΔΧ concluding his or her final professional year of study in spring 2023.

       

      Before completing the nomination form below, please ensure that you have:

      • a personal statement not to exceed 500 words in which the nominee expresses a vision of what he or she aspires to accomplish within 10 years after graduation, and
      • three letters of recommendation that address the nominee’s potential for exceptional leadership in the profession after graduation. One of the letters must come from the Chapter Advisor.

       

      The PLEI Board of Directors will determine the honoree and the recipient will be announced in late June.

       

      Please direct any questions on the form or the award to Lori Carey.

       

      Schlegel Award Nomination 2023

      Pharmacy Leadership & Education Institute (PLEI) John F. (Jack) Schlegel Leadership Development Award

      Name of Nominee
      Current Address
      Durable Address
      Please include a permanent address, such as parents or family.
      MM slash DD slash YYYY
      College(s) attended prior to Pharmacy School (full time equivalent years and degree(s), if earned).
      (Add additional schools by pressing the + icon).
      College Attended
      Years Attended
      Degree(s) Earned
       
      Pharmacy Work Experience over the last 5 years, most recent first (clerk, technician, CPhT, or intern. EXCLUDING IPPEs and APPEs).
      (Add additional employers by pressing the + icon).
      Employer
      Role
      Dates Employed
       
      College Non-Pharmacy Paid Work Experience over the last 5 years, most recent first.
      (Add additional employers by pressing the + icon).
      Employer
      Role
      Dates Employed
       
      Scholarships - Include reason (e.g., merit, financial need, scholastic level, service, or professionalism, group affiliation, etc.), the dates received and the awarding organization.
      (Add additional scholarships by pressing the + icon).
      Scholarship Name
      Reason
      Date(s) Received
      Awarding Organization
       
      Awards - Include reason (e.g., merit, scholastic level, service, professionalism, group affiliation, etc.), the dates received and the awarding organization.
      (Add additional awards by pressing the + icon).
      Award Name
      Reason
      Date(s) Received
      Awarding Organization
       
      Describe each pharmacy organization in which nominee is a member. For each, indicate any elected or appointed office or roles. Indicate accomplishments or contributions attributable to the nominee.
      Include local or state pharmacy associations, your PDC chapter, etc. (Add additional organizations by pressing the + icon).
      Organization
      Member since
      Elected office(s)
      Other role(s)
      Accomplishments, Contributions
       
      In 500 words or less, please explain what you aspire to accomplish within 10 years of graduation, in terms of leadership within the profession. Please upload a file with the personal statement.
      Drop files here or
      Max. file size: 100 MB.
        Please upload three letters of recommendation that address the nominee's potential for exceptional leadership in the profession after graduation through exemplary behaviors and actions that gain the respect of peers. a.)One letter must be submitted by the Phi Delta Chi Chapter Advisor. b.)We suggest that a letter address the qualitative or quantitative contributions of the nominee in the college community (e.g., a college or university administrator). c.) We suggest that a letter may be written by a community representative addressing the qualitative or quantitative contributions of the nominee (e.g., community coalition, state association, etc.).
        Drop files here or
        Max. file size: 100 MB.
          Acknowledgement
          This field is for validation purposes and should be left unchanged.