Expression of interest for Postgraduate Certificate in Clinical Pharmacy in Prescribing

Welcome to the expression of interest submission process for the Postgraduate Certificate in Clinical Pharmacy in Prescribing. This form has been created for New Zealand pharmacists to express an interest in entering the programme.

This programme is currently subsidised by Health New Zealand - Te Whatu Ora. This funding covers course fees, a stipend to contribute towards travel costs to attend weekend study days in Auckland and an incentive payment for medical supervisors who are willing to support students.

Places are limited, so this process allows us to identify potential students who will be invited to formally apply to enter the programme.

We ask you to submit an up-to-date CV, so you may wish to get this document ready beforehand.

Please review the University's prerequisites and the Pharmacy Council's requirements using the links below.

Postgraduate Certificate in Clinical Pharmacy in Prescribing - The University of Auckland
Registration Requirements for the Pharmacist Prescriber Scope

If you have any questions about this form please contact Rhys Ponton or Louise Curley.

Personal information

First name/s

Phone number

Surname

Email address

Home address

Street address

Town/city

Region

Postcode

Qualifications

What undergraduate pharmacy qualification do you hold?

If other, please specify

Where did you complete your undergraduate pharmacy qualification?

If overseas, please specify

Do you have any postgraduate qualifications?

What postgraduate qualification/s do you have?

Postgraduate Certificate in Clinical Pharmacy (PGCertClinPharm) or equivalent

Postgraduate Diploma in Clinical Pharmacy (PGCDipClinPharm) or equivalent

Master of Clinical Pharmacy (MClinPharm) or equivalent

Postgraduate qualification in specific clinical area

Work

What pharmacy setting do you currently work in?

If other, please specify

Name of your workplace

Location of your workplace

Does your workplace support you to take the prescribing course and move into a prescribing pharmacist role?

Primary Training Workplace (if different than workplace listed above)

Primary Training Workplace Address

Do you currently work with a particular group or in a particular clinical area?

If yes, please specify

Do you know what clinical area or prescribing field you would choose to focus on during the prescribing course?

If yes, please specify

Please include any other information that you think is important for us to know

Please upload a copy of your CV

Upload file

Designated Medical Practitioner Information

Please note: If you are accepted onto the programme, an agreement will be sent that needs to be completed by your Designated Medical Practitioner (DMP), and their employer. These agreements outline the requirements of your DMP and their commitment to providing clinical supervision while you study, and the funding that will be allocated to their employer to support this.

Name of DMP

DMP primary workplace

Agreements

I confirm that I am a member of a multidisciplinary team which includes my DMP.

I understand that it may be beneficial for discussion and feedback to occur between the University of Auckland and my Designated Medical Practitioner regarding my progress throughout my study programme.

I confirm that my immediate line manager, or higher, is aware of my enrolment in the prescribing programme.

Please do not enter any credit card information into this form.