Desire to Serve Form (2019-20) Desire to Serve Step 1 of 6 - Personal Information 16% Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* I am a...*Select...PharmacistPharmacy TechnicianStudent PharmacistYear of Graduation*Degree Received*If you have not yet received a degree, please list the degree you are working towards.School Name*Job Title*If you are not currently working, please type N/A.Please list your top 5 leadership strengths:* Preferably your Strength-Finder strengths All Board of Trustee positions are elected positions. Elections take place each year.Committee AppointmentsEach year, the President of the California Pharmacists Association appoints individuals to serve on various committees. Once ratified by the Board of Trustees, members will begin serving on their respective committees beginning at the House of Delegates meeting following ratification. Most committees meet by conference call monthly, bimonthly or quarterly. Committee terms vary from 2-3 years and are great opportunities to provide value to the direction of the Association. Members appointed to a committee must maintain an active membership within CPhA. Audit Committee (3-year term) Awards Committee (3-year term) Editorial Review Committee (3-year term) Education Advisory Committee (2-year term) Elections Committee (3-year term) Insurance Committee (3-year term) Investment Committee (3-year term) JCPhP Associate Editor (2-year term) Legislative Committee (3-year term) How many committees do you wish to be appointed to?*Please enter a number from 1 to 9. Elected Positions President (3-year commitment as President-Elect, President, Immediate Past President) Treasurer (2-year term) At-large Trustee (3-year term) Student Trustee (1-year term) Members of the Board of Trustees are elected to leadership positions by the membership and are charged with developing the vision, strategy and fiscally oversight of the organization. The Board of Trustees, along with CPhA committees, taskforces, and academies, builds leadership skills in our members. Note: Only fill out this section if you are seeking an Elected Position.If you have selected more than one office, please rank your preferences below. Special Interest Group: Chair-ElectSpecial Interest Groups (SIGs) formerly known as Academies, represent each pharmacy practice setting in California. Led by a Chair and Chair-Elect, SIGs provide subject matter expertise to the Board of Trustees and CPhA membership on information relating to respective practice settings. SIG Leaders provide an opportunity for professionals in a specific practice setting to collaborate and direct the future of the profession. In some instances, SIGs recommend policy and legislative action to the Board of Trustees and the legislative committee. All Special Interest Group Chair and Chair-Elect positions are elected during the House of Delegates. Terms are for a period of two years, serving first as Chair-Elect, and then as Chair. Ambulatory Care SIG Community Pharmacy SIG Compounding SIG Inpatient Care SIG Long Term Care SIG Managed Care SIG Pharmacy Ownership SIG Pharmacy Technician SIG If you have selected more than one SIG, please rank your preferences below.All committee positions are appointed by the President and ratified by the Board of Trustees.Committee Descriptions Conference Delegate and House of Delegate AppointmentsThe California Pharmacists Association is active in other pharmacists associations throughout the country. Due to our involvement, CPhA members are often asked to represent the profession of pharmacy in various delegations throughout the country. An Elected Delegate is required the organization's House of Delegates meeting. Delegates are provided with stipend upon completing their delegate responsibilities. To be considered as a delegate, please indicate your preferences below. Delegate elections will take place annually at the House of Delegates (September 2020). Terms are indicated below and active memberships in both CPhA and the Delegation you are representing is required. Nominating Committee members serve to identify candidates for Delegate positions. Nominating Committee meets annually, prior to the start of the House of Delegates meeting. Policy and Reference Committee members assist in drafting policy proposals for consideration by the membership during House of Delegates. APhA Delegate (3-year term) NCPA Delegate (3-year term) Speaker (2-year commitment as Speaker-Elect, then Speaker) Nominating Committee (1-year term) Policy Committee (2-year term) Reference Committee (1-year term) Have you served as a Delegate in years past?YesNoDelegate Experience: If you answered yes to the question above, please indicate the capacities in which you have served as a Delegate representing the California Pharmacists Association. Please describe your CPhA or other pharmacy association activities within the past 5-10 years. (i.e. 2014 CPhA Delegate, 2012 CPhA Regional Trustee, CSHP Board Member, etc.) Note: Please do not copy and paste your resume.*What skills, strengths and values do you have which will contribute most to the position(s) you are seeking?*Is there any other information you would like the President or Elections Committee to consider when reviewing your Desire to Serve form?*For those seeking elected office, please include a biography, which will appear in campaign materials.For those seeking elected office, what experience do you have that you feel would help CPhA meet our mission and goals identified in the Strategic Plan?Please upload a copy of your CV.*For those seeking elected office, please upload a professional photo for use in campaign materials.