MPhA Ambassador Program- Ambassador Interest Form
MPhA Ambassadors fosters leadership through mentorship, with the main objective being to connect experienced MPhA members with new members to help orient new members (and interested longer term members) to the association and its resources. Ambassadors act as mentors and would also serve to create a path for new members based on their professional interests. They would also help connect mentees with association resources that are related to their career interests and help foster their professional and leadership development.

Minimum requirements for serving as an Ambassador:
1. be an active member of MPhA*
2. must have been an active MPhA pharmacist member for at least 2 years
3. have experience serving in an MPhA committee or work group (does not need to have held a leadership position although this is preferred)

*According to the MPhA Constitution, an active member is any pharmacist in good professional standing who has a valid license to practice pharmacy in any state
Name (First and Last) *
Credentials *
primary email *
In which geographical area do you currently reside? *
current job title *
current employer *
previous positions *
Current Practice Area *
What practice area(s) are you comfortable mentoring in besides your current practice area? *
Year graduated pharmacy school *
Pharmacy School attended *
Number of years as an MPhA member *
List any leadership positions held in MPhA *
List any MPhA committees or work groups you have participated in. *
Why are you interested in serving as an Ambassador (mentor)? *
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