LaSE Foundation Pharmacist Legacy Programme Application form

Please complete this application form and attach the FP Registration to the programme 2020 excel spreadsheet upon submission

This form should be completed by the FP EPD

Forename
Surname
Job Title
Work Email
Telephone (work)
Mobile (emergencies only)

If your Organisation is not listed on the dropdown above, please enter below.

Organisation Other
Address 1
Address 2
Town
County
Postcode

Submission of registration to the LaSE Legacy Foundation Programme

Please complete the FP Registration to the programme 2020 excel spreadsheet available to download from the page above. Zip the file and upload it here

Attach file
I agree to the Terms & Conditions as outlined in the Learning Agreement

Please refer to the HEE privacy notice https://hee.nhs.uk/about/privacy-notice for information on how HEE manage your data.

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.