Award Nomination Form

Can you help us find Australia’s best pharmacy intern?

The Pharmacy Guild of Australia is pleased to partner with MIMS Australia in the search to find the 2020 Intern of the Year.

Criteria for judging the Intern of the Year

The MIMS / Guild Intern of the Year judging panel will be looking for the Guild ITP intern who best demonstrates excellence in one or more of the following criteria:

- Patient-centred practice
- Improving the health of communities
- Innovative pharmacy practice
- Integrity, honesty and professionalism
- Teamwork, communication and reliability
- Response to the COVID-19 pandemic

Who can nominate?

Candidates for the MIMS / Guild Intern of the Year may be nominated by:

- The intern’s supervising preceptor
- The intern’s employer
- The intern themselves (self-nominated)
- A pharmacist or other colleague who works alongside the intern.
- A Guild ITP clinical tutor

Details of intern being nominated

Intern First Name*

Intern Last Name*

Intern Pharmacy Name (where the internship was undertaken)*

Intern Pharmacy Address*

Intern Telephone Number*

Intern Email Address*

Details of person making the nomination

Your First Name*

Your Last Name*

Your Position / Role*

Your Relationship to the Nominated Intern*

Your Work / Practice Address*

Your Telephone Number*

Your Email Address*

I believe the intern demonstrates excellence in the following categories (please tick as many as apply):*

Patient-centred practice

Improving the health of communities

Innovative pharmacy practice

Integrity honesty & professionalism

Teamwork communication & reliability

Response to the COVID-19 pandemic

Reason(s) for nominating the candidate*

Provide a short summary of community and/or pharmacy projects the intern has been involved with during their intern year that make them a good candidate for the MIMS / Guild Intern of the Year 2020: (100 to 200 words as an approximate guide)

I agree to the Terms and Conditions*

Yes

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