Leadership training registration form

This enrolment form is for NPA members, if you are currently not in membership with the NPA please initially contact our Membership Department (01727 795914)

If you have concerns about the literacy and numeracy skills of your candidate, contact the Member Services team on 01727 800402 to discuss the matter before submitting this form.

This form must be completed by the supervising pharmacist.

Are you a supervising pharmacist/technician?*

Yes

If you are the student or would like to enquire about a course please complete the course enquiry form.

Which course are you interested in?*

Our MCDC course is a combined version of our Medicines counter course and our Dispensary assistants course. Please make sure, you select the right course upon enrolment.

How would you like to study this course? (click on the arrow to reveal more formats, if available)*

How did you hear about this course?

If other, please specify

Candidate Details

Title*

Forenames*

Surname*

Email Address*

Please ensure this email address is unique to the candidate, we will use this for the purpose of contacting the student.

Date Of Birth*

Hidden

GPhC number

Student mobile

Please include a space between the area code and line number e.g. 01234 567890. By providing your number, you are agreeing for the NPA to use it for SMS alerts and reminders relating to your course.

Supervising Pharmacist/Technician Details

Title*

Forenames*

Surname*

GPhC no.*

Email Address*

Please ensure this email address is not shared and is unique to the pharmacist, we will use this for the purpose of emailing login details

I confirm that:

I am the permanent supervising pharmacist/supervisor of this student and have discussed the implications and limitations of this training and the role with the student and consider them to be a suitable candidate.*

The candidate will have regular training time in the dispensary (we advise this to be a minimum of 14 hours/week)*

I am willing to support the student throughout the training.*

I have carried out a personal assessment of the student’s capabilities.*

The candidate has demonstrated that they can dispense 200 items accurately and I believe that they have the correct behaviours and skills to become an accuracy checking technician

Northern Ireland only - I understand that the trained accuracy checking technician will need to complete and submit a portfolio every two years, to remain certified as an accuracy checking technician.

Pharmacy Details

NPA Member No.*

Pharmacy Name & Address

This will help us to identify you along with your Member No.

Important Information

Data Protection Notice

It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read our Privacy Statement, which you can find at Privacy Notice.

Terms of Service*

Read our full Terms and Conditions here.

I agree to the Terms of Service

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Comments

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