NCPAFoundationStudent PresidentialScholarships

Recognizing Outstanding Academic& Leadership Achievement

by Providing Educational Assistance to Pharmacy Students

Donor Pledge Form

Thank you for supporting the NCPA Foundation. Please complete this form for your pledge support and mail or fax it to the NCPA Foundation. Please call Kathryn Kuhn at 703-838-2654 if you have any questions. The 2009 deadline is April 15.

Scholarship Information ($3,500 per scholarship)

Number of scholarships you would like to support (e.g., 1, 2, 5, etc.): ______@ $3,500 each

Donor Information

______

Today’s date Name of main contactTitle

______

CompanyTelephone numberFax number

______

AddressCityStateZIP

Payment

 A check for my donation in the amount of $______is included with this form. Make check payable to: NCPA Foundation.

 Send me an invoice in ______2009 in the amount of $______.

 I plan to make a yearly commitment to the program for ____ years.

No, at this time, I do not wish to contribute to the Presidential Scholarship Program. But please accept my general

donation to the NCPA Foundation in the amount of $______.

Benefits to You

Encourage academically talented pharmacy studentsSupport future independent pharmacistsAs a scholarship benefactor, your company’s representative is invited to present the scholarship award at the “NCPA Foundation Awards Ceremony and Reception” during the 111th NCPA Annual Convention in New Orleans, LA, October 17-21, 2009Your company’s visibility is also promoted in numerous ways, such as prominent acknowledgement with your company’s logo in the Awards Program, event signage, a photo opportunity with scholarship recipients, and podium acknowledgement during the ceremony proceedings; recognition on the NCPA Foundation website, in the NCPA Foundation Annual Report, introductory slides prior to the General Session during the NCPA Annual Convention, America’s Pharmacist magazine, NCPA’s e-News Weekly, the New Independent student newsletter, the NCPA onsite convention daily newspaper, and promotionsJoint press release with the NCPA Foundation

Benefits to Students

Tuition supportRecognition in the pharmacy and education communities for high academic and leadership successNetworking opportunities at the 111thNCPA Annual Convention (October 17-21, 2009 in New Orleans, LA) with independent pharmacy owners and pharmacy students from across the nation

Established in 1953, the NCPA Foundation supports the growth and advancement of independent pharmacy through low-interest educational loans and scholarships to pharmacy students, critical research,disaster relief, student outreach, and education. The NCPA Foundation is a charitable, nonprofit 501(c)(3) organization (federal tax ID#36-6072250), and contributions to the NCPA Foundation are tax-deductible as charitable donations to the extent permitted under federal tax law.

The National Community Pharmacists Association Foundation

100 Daingerfield Road  Alexandria, VA 22314-2888

703-683-8200  Fax: 703-683-3619 