Faculty Committee Nomination Form – Community | The National Institute for Pharmaceutical Technology & Education

Complete this form for each person you would like to nominate to the Faculty Committee.

Member Organization *

Please select your member organization. If your organization isn't on this list, please contact the NIPTE office.

Nominator Information

Please provide your information below.

Nominator name *

First

Last

Nominator Title *

Only department head's or immediate supervisors can nominate someone for the NIPTE Faculty Committee

Nominator email *

Nominee Information

Please enter the information for the person you would like to nominate to the Faculty Committee. This person must be from your organization as named above.

Nominee name *

First

Last

Nominee Title *

Nominee email *

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