REGISTRATION FORM: Joint Programmes Board

The purpose of this form is to register you with the Joint Programmes Board - UCL School of Pharmacy. This will allocate a JPB registration number that must be noted and used for further communications.

Use the 'Send Registration Form' button at the end to submit your application. The form will automatically check some entries for validity before submission and request changes if errors are detected. You will be sent immediate confirmation by email that the submission was successful. Help notes for completion of form:

  • Data from the form will not be submitted until you click the 'Send Registration Form' button at the end.
  • A partially complete form will retain data while the browser window remains open.
  • More details about the JPB Diploma in General Pharmacy Practice and the enrolment options can be be viewed via this Explanatory link which will open in a new window.

All new students must complete this form at the start of their programme at the UCL School of Pharmacy. The information on your application and enrolment forms will be used in accordance with the School's data protection policy. For further information about why we collect the data and who we give it to, see: www.pharmacy.ac.uk/dpa.html. Please type in the form boxes. Use the tab key to move between entries

Personal Details
Title:
First name: Other names: Last name:
       
Gender
 Male Female
DOB
dd/mon/yy)
     
email:
Confirmation will be sent to this email address.
email:
 Please confirm your email and please ensure that it is exact.
     
  GPhC Year of Registration:  
  No:       
       
 
Type of JPB application:
 Standard entry applicant
 
Interim entry applicant - Explanation link
     
Nationality for immigration purposes: UK       Dual UK       EU       Other
 
If not British or dual British with another country please fill in the following:
In which year did your UK residency begin:
 yyyy
  
If not UK, dual or EU national what is your Immigration status:
    If other please specify:
If you have a status other than indefinite leave to remain, when does your visa expire:
 yyyy
     

 

Residential Address:    
Where you normally live.
Line 1:
Telephone:
Ext: if any
line 2:
Mobile:
Line 3:
Line 4:
Work telephone:
Ext: if any
Postcode:
Fax:
 
Alternative email:
 

 

Centres and Educational Programme Director (Lead Tutor)
 Notes link
 
Hospital
Other if not listed
Educational Programme Director
Title First name Last name  
 
Educational Programme Director email
Confim EPD email
 

Applicants are expected to have discussed the application with and have the agreement of their lead tutor.
Application submissions without a designated lead tutor will not be accepted.

Educational Supervisor (Practice Tutor) if decided
 Notes link
Your Educational Supervisor
Title First name Last name  
 
Practice Tutor email:
Confim Practice Tutor email
 

If you do not have a supervisor please put unknown as the supervisor's names and use your own email address as the email.

PART B: Statistical Data

This data is not part of the application but we are required to collect it.
New Entrants to UK Higher Education:
Please tick if this is the FIRST course you have studied at a university in the UK.
If you checked the box - in which country did you previously study:

Statistical Data   Notes link
  (If not in list please select 'Other') Please state if not listed:
Country of domicile:
Nationality:
Ethnicity:
select
Disability and Special Needs:
 


University Education
Qualification University Classification Date Obtained (Year)

Academic and Professional Qualifications
Qualification Awarding Body Subject Date Awarded (Year)

 

PART C: Fees

Fees: Please select the applicant type and a fee option: Notes link
The sponsor below is paying my fees  
I will be paying all of my fees  
   

 

Sponsor: To whom invoice should be sent
Address:
 Notes link

Name:
Line 1:
   
Line 2:
Spon.email:
Line 3:
confim
Spon.email:
Line 4:
     
P.code:
Tel.No.
Ext:
    
         
Does your hospital require purchase order numbers for invoicing purposes: Yes        No
If Yes please enter your purchase order number:

 

Please include a comment if you feel you need to add further information.
 
 characters left.
     

 

DECLARATION
 
I confirm that the information I have provided is complete and accurate.
  I confirm that I will not register concurrently for more than one degree, diploma or certificate or any combination of these awards at the UCL School of Pharmacy. I also confirm that I will not register concurrently for the equivalent qualifications at any other university or institution.
 
I agree to abide by the regulations, policies and procedures of the UCL School of Pharmacy while I am enrolled as a student.
 
I understand that if I ever submit false or misleading information to the UCL School of Pharmacy regarding my educational qualifications or immigration status for the purpose of fee status, I may face immediate dismissal from the School.
  I understand that the Postgraduate Diploma in General Pharmacy Practice is a work based programme and agree to the School sharing data with my Trust.
Please only tick if you object to the School sharing data with your Trust
     

 

Please click 'Send Registration Form' only once. Expect it to take a few moments for the site to respond.

After submission of this form completes you will receive a confirmatory email to the address you have given above.
If you do not receive this email, the submission of your details was not successful. In this case please try again.

If you continue to have problems please email to the postgraduate admin mail address at the UCL School of Pharmacy

 

Return to JPB Registration page