COP 20th Anniversary Awards Nominations Form

  • Recipients will be chosen on the basis of their excellence and distinction in the major components of the WesternU College of Pharmacy (COP) mission: Science, Caring, and Humanism. The College of Pharmacy will be honoring alumni who have made significant contributions to both the university and community, and whose accomplishments, affiliations, careers and/or services reflect WesternU’s COP legacy of excellence. Please click here for the awards criteria.

    Awards:

    • Distinguished Alumni Award
    • Alumni Achievement Award
    • Outstanding Young Alumni Award
    • Distinctive Service Award

    Alumni, Faculty, staff, students or friends of WesternU COP may submit a nomination. All WesternU COP alumni and supporters are eligible for nomination. To nominate an outstanding individual, please complete the form below.

    The nominator must provide all materials pertinent to the nomination. All nominations must be submitted by August 30, 2016.

  • Information about the Nominator:

    Required fields are marked with an asterisk (*)
  • If you selected other, please specify

  • Information about the Nominee:

    Please fill in all known information.
    Required fields are marked with an asterisk (*)
  • Please provide a brief explanation as to why this individual should receive this award. Include examples of Excellence, Honors and Recognitions, Community Service, University Service, Mentorship, Preceptorship, Professional Involvement, Innovation, & any other details you can provide to assist the Awards Committee in making a well informed decision.

  • Nominee Supporting Documentation:

  • Drop files here or
    Max. file size: 125 MB, Max. files: 5.
      Please do your best to include a recent photo of the Nominee. If your file exceeds the size limit , please send by email to rxevents@westernu.edu.
      By submitting this form, I agree that the accuracy of the information I am providing to WesternU College of Pharmacy is both factual and verifiable.