Annual Chapter Report Form | The Rho Chi Pharmacy Honor Society
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Annual Chapter Report Form | The Rho Chi Pharmacy Honor Society
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Annual Chapter Report Form

ANNUAL CHAPTER REPORT FORM

"*" indicates required fields

Step 1 of 12 - Chapter Info

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MM slash DD slash YYYY

I. Chapter Information

II. Chapter Officers

Current Chapter Officers
Please use dropdown to select the title that applies. Click the + to save entries and add additional rows. If you need to add an item that is not in the list, simply type it in title and press enter. (i.e., Liaison, Coordinator).
Title
First Name
Last Name
Email Address
 

III. Advisor(s) Contact Information

The primary advisor is responsible for submitting this form.
Primary Advisor's Name*
Additional Advisor(s)
First Name
Last Name
Email
Phone
 

IV. Chapter History/Background (Max 500 words)

Example: how old is the school, anything unique to the school, when was the chapter established
PharmD Program Structure
Check all that apply.
Did the chapter follow Rho Chi Initiation Ritual procedures?
MM slash DD slash YYYY
Who presided over the initiation ritual?

V. Objectives / Strategic Plan

Select the objectives from Rho Chi’s 2019-2023 Strategic Plan from below and provide your chapter’s specific strategies for meeting the objectives you selected. A minimum of one objective must be selected. (Note: You do NOT have to select every objective, please only select objectives that most apply to your chapter's activities)
(EXAMPLE) - Identify the chapter-specific strategies that support the selected objectives. (Note: activity details/supporting information will be reported in the Service or the Intellectual Inquiry Activities sections) 1. Example: Foster collaboration. Strategy: Develop a social media plan to facilitate communication among Rho Chi chapter committees.
Please select a minimum of one (CTRL + Click to select or deselect more than one)

VI. Meeting Planning/Business Organization Details

Please provide one abbreviated example of chapter minutes and board minutes by listing topics discussed. (200 words)

VII. Service Activities **

** Activities counted in this section, may not be repeated again in any other section.

List up to 10 Service Activities that encompass events your chapter does to help peers and your community. (Examples: outreach events, tutoring, and health fairs.) Report the same activity provided multiple times in aggregate (e.g. tutoring services for multiple courses; same health fair conducted on three different days; a diabetes awareness outreach education program provided at two senior centers; etc.). If different and separate service activities were developed/provided, each event can be reported as an individual activity (e.g. an outreach program on diabetes awareness to seniors and an outreach program on medication safety to children can be reported as two activities).

Do you have any service activities you wish to report?

Service Activity 1

Is Activity 1 new or an existing activity?
Have there been any modifications to Activity 1 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 2

Is Activity 2 new or an existing activity?
Have there been any modifications to Activity 2 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 3

Is Activity 3 new or an existing activity?
Have there been any modifications to Activity 3 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 4

Is Activity 4 new or an existing activity?
Have there been any modifications to Activity 4 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 5

Is Activity 5 new or an existing activity?
Have there been any modifications to Activity 5 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 6

Is Activity 6 new or an existing activity?
Have there been any modifications to Activity 6 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 7

Is Activity 7 new or an existing activity?
Have there been any modifications to Activity 7 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 8

Is Activity 8 new or an existing activity?
Have there been any modifications to Activity 8 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 9

Is Activity 9 new or an existing activity?
Have there been any modifications to Activity 9 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

Service Activity 10

Is Activity 10 new or an existing activity?
Have there been any modifications to Activity 10 in the last year?
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Patients, students, etc)
Example: 10 patients were educated on the risk of high blood pressure to help improve their outcomes.
Example: post-survey of the 10 patients evaluated their knowledge of the risks of high blood pressure and their satisfaction with the education.

VIII. Intellectual Inquiry Activities **

** Activities counted in this section, may not be repeated again in any other section.

List up to 10 Intellectual Inquiry Activities your chapter has done that have contributed to scientific knowledge. (Examples: publishing in a peer-reviewed journal, abstract/poster presented at a conference, podium presentation at a conference, in-service to providers, and local university poster presentation.) Report the same activity in aggregate (e.g. poster presentation delivered at a national conference and encore provided at a regional meeting; same abstract submitted to two conferences; continuing education program presented twice; etc.). Different intellectual inquiry activities stemming from the same research can be reported separately (e.g. abstract, poster, and manuscript based on the same research accepted for publication/presentation can be reported as three activities).

Do you have any Intellectual Inquiry Activities you wish to report?

Intellectual Inquiry Activity 1

Is Intellectual Inquiry Activity 1 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 1 in the last year?
Was Intellectual Inquiry Activity 1 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 2

Is Intellectual Inquiry Activity 2 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 2 in the last year?
Was Intellectual Inquiry Activity 2 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 3

Is Intellectual Inquiry Activity 3 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 3 in the last year?
Was Intellectual Inquiry Activity 3 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 4

Is Intellectual Inquiry Activity 4 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 4 in the last year?
Was Intellectual Inquiry Activity 4 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 5

Is Intellectual Inquiry Activity 5 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 5 in the last year?
Was Intellectual Inquiry Activity 5 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 6

Is Intellectual Inquiry Activity 6 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 6 in the last year?
Was Intellectual Inquiry Activity 6 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 7

Is Intellectual Inquiry Activity 7 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 7 in the last year?
Was Intellectual Inquiry Activity 7 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 8

Is Intellectual Inquiry Activity 8 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 8 in the last year?
Was Intellectual Inquiry Activity 8 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 9

Is Intellectual Inquiry Activity 9 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 9 in the last year?
Was Intellectual Inquiry Activity 9 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

Intellectual Inquiry Activity 10

Is Intellectual Inquiry Activity 10 new or an existing activity?
Have there been any modifications to Intellectual Inquiry Activity 10 in the last year?
Was Intellectual Inquiry Activity 10 published, presented or disseminated outside of the school?
Examples: Information was published in a peer-reviewed journal, abstract/poster presented at conference, podium presentation at conference, in-service to providers, local university poster presentation.
(i.e. Rho Chi member and other association/organization, if done in collaboration, and number of participants)
(i.e. Students, etc)
Example: Rho chi organized a school wide poster presentation of student research projects.
Example: post-survey of students and faculty who attended the poster presentation assessed awareness of colleagues’ research projects

IX. Alumni Relations

This field is hidden when viewing the form
Do you have any Alumni Related Chapter Initatives you wish to report?

Alumni Related Chapter Initiatives

Examples: invitation to speak at induction ceremony, recognition through awards, mentor program, invitations to attend/precept Rho Chi events, newsletters.
Examples: Presented to Rho Chi students, precepted a Rho Chi event, hosted a Rho Chi event or served as a mentor, attended Rho Chi events
Did your chapter nominate an alumnus for the Rho Chi Alumni Honor Roll this past year?
Provide who you nominated for the Alumni Honor Roll

X. Overall Budget

(DO NOT PROVIDE FOR EACH EVENT; use table provided to report annual budget):
Overall Budget Items:
Please use dropdown to select each category that applies. If you need to add an item that is not in the list, simply type the name and click + to save and add another row. (i.e., Scholarship award).
Item Name
Amount
 

XI. Chapter Awards

Did your chapter apply for the Chapter Project Proposal Award in the current award cycle?
Did your chapter receive the Chapter Project Proposal Award in the current award cycle?
Spring Submissions - Deadline January 15 / Summer Submissions - Deadline June 1

XII. Most Improved Chapter (Optional)

Would your chapter like to be considered for the MOST Improved chapter?
Only chapters who have submitted an annual report the previous year are eligible.
The recipient of the Most Improved Chapter will receive a certificate, $500 award, and recognition during the Annual Rho Chi Meeting. The award is determined by the chapter’s brief descriptive summaries and sustainability of new activities implemented during the current reporting year. (Max 300 words per area: Alumni Relations Activities, Intellectual Inquiry Activities, and Service Activities)
This field is hidden when viewing the form
Describe what your chapter did in the previous year (2020-2021);
How has your chapter improved in this area for the 2021-2022 year and how are the changes sustainable?
Describe what your chapter did in the previous year (2020-2021)
How has your chapter improved in this area for the 2021-2022 year and how are the changes sustainable?
Describe what your chapter did in the previous year (2020-2021).
How has your chapter improved in this area for the 2021-2022 year and how are the changes sustainable?
Overall, why should your chapter be considered for the Most Improved Chapter Award?
 
 

Please Note...

Please remember that you should only submit the form when it is complete. Once it has been submitted, there is no way to edit or change anything. If you need to gather more information or have someone else fill in a section, click on SAVE AND CONTINUE LATER. You will be provided a link to come back to your application or to share with someone to complete the process.

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University of Michigan, College of Pharmacy
428 Church Street, Ann Arbor, MI 48109-1065
Office: (734) 615-4898 ~ Email: RhoChiSociety@umich.edu
Website: www.rhochi.org

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    • A. Wayne Pittman Outstanding Service Award
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      • Clinical Research Scholarship
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      • New Advisor Report
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      • Annual Chapter Report
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