Trainee Self-Update Form

It is important that HEE LaSE Pharmacy Team have up-to-date information on all trainees and their educational supervisors. Any trainees who change personal details, trust or educational supervisor should complete the below form.

Forename
Surname
Please tick the information that requires updating, tick all that apply:
Contact details
Trust/Organisation
Educational Supervisor
Other

Please complete the following fields

name
Personal Email
Trust/Work Email
name
Telephone (work)
Mobile (emergencies only)

If your Trust/Employer is not listed on the dropdown, please enter below.

Trust/Employer Other
Base Name

Educational Supervisor Details

name
Educational Supervisor Forename
name
Educational Supervisor Surname
Educational Supervisor Email
Other information to be updated:

Please note: If you are a Foundation Pharmacist completing this form with an Educational Supervisor change.
Please download, complete and submit the learning agreement to lasepharmacy@hee.nhs.uk.