MPSA Post-Event Summary
Please fill out this form after every event or general meeting that you plan within MPSA. Thank you!
Name *
Your answer
x500 *
Your answer
Your leadership position and group within MPSA *
Your answer
Name of additional members that planned the event
Your answer
Campuses Involved *
Collaboration Organization *
All MPSA initiatives, school initiatives, and community initiatives need to be included. Examples: State Pharmacy Association and SSHP Chapter, NCPA, or none
Your answer
Name of Event/Activity/Meeting/Project(s) *
Examples: For an individual event- APhA-ASP Chapter Meeting: Professionalism Speaker, For a month long program- HPV Awareness Campaign during American Pharmacist Month, For recurring events or meetings- IPhO Chapter Meetings
Your answer
Classification of event *
This may include more than one classification
Required
Date of event *
MM
/
DD
/
YYYY
Dates of events (if recurring event)
Month, day, year for each recurring meeting/event
Your answer
Location of Event/Meeting *
City, State only
Your answer
Promotional Materials used for event (advertising): *
If "Other," be specific. Examples: Governor’s proclamation, Walgreen’s reader boards, HPV awareness letter, HPV Public Service Announcements, web sites
Required
Target Audience *
Example: College of Pharmacy Students, Pharmacists, and Faculty, Citizens of State, Chapter Members
Your answer
Number of Faculty Present *
Number or number per meeting
Your answer
Number of Additional Pharmacist(s) Present *
Number or number per meeting
Your answer
Number of Chapter members present *
Number or number per meeting
Your answer
Number of Patients that attended the event *
Number or number per meeting
Your answer
Number of Patients that received wellness/clinical services *
Number or number per meeting. This may include blood glucose testing, bone density testing, or referral references.
Your answer
Number of Patients reached through public relations *
Estimate based off of promotional materials used for advertising and target audience
Your answer
Event Type *
Required
If the event is continuing from previous years, how many years has it taken place (if known)?
Your answer
Total Number of Hours for Event Planning *
Total, or total and (hours per meeting)
Your answer
Total Number of Hours of Event *
Your answer
Synopsis of event (75 words or less) *
Your answer
Comments or concerns?
Your answer
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