REGISTRATION FORM: Joint Programmes Board

The purpose of this form is to register you with the Joint Programmes Board. 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.

Please read the information about Data Protection on our web site.

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.
     
  Roy.Pharm.Soc.GB.Registration Year of Registration:  
  No:       
       
 
Type of JPB application:
Standard entry applicant


Interim entry applicant - Type Explanation
     
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 Lead Tutor
Academic centre Hospital
 
Other if not listed
LeadTutor First name Last name  
 
Lead Tutor email
 
Confim 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.

Practice Tutor if decided
Your Tutor First name Last name  
 
Tutor email:
 
Confim email
 

If you do not have a tutor please put unknown as the tutor'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 D: 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:
email:
Line 3:
confim:
Line 4:
 
Postcode:
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.
     

 

 

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 admin mail address at the JPB

 

Return to JPB Registration page