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ACT Educators Badge Application

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ACT Community Pharmacy Transformation Educators Badge Application

The Cohort 4 application cycle for the Community Pharmacy Practice Transformation Educators Badge Program is now open. Please complete and submit this form to apply for the program.

Please note: If accepted into the program, a required fee of $149 will be charged.

Indicates required field
(If different than First Name)
(e.g., Pharm.D., Ph.D.)
(e.g., Assistant Professor)
(e.g., Pharmacy Practice)
(If Applicable)
I consent to sharing my contact information with other badge participants via a directory that will only be made available to current and past badge cohort participants.
 
I understand that if I am accepted into the program, I am agreeing to complete the ACT Pharmacy Collaborative Community Pharmacy Transformation Educators Badge. I am agreeing to complete all requirements necessary to achieve the Badge. This includes attending 4 live networking sessions. I also understand that failure to complete requirements by the established deadline in Summer 2026 will result in not achieving the Badge.  
 
Please describe in 3-5 sentences:
1. Your interest in this program and how it would contribute to your professional development.
2. Which pharmacy and/or organization (and other collaborators, as applicable) you plan to partner with to complete the engagement/implementation portion of this program.

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