BPharm2 PHC Placement 2018


STUDENT NUMBER:	Please note that the preferred period for the Community Placement is during the September vacation, however, due to the large number of students, some students will be placed during the November/December vacation
TITLE:
FIRST NAME:
SURNAME:
EMAIL ADDRESS:
CELL NUMBER:
Location Preference:	Placement preference: Please provide two options for Community Pharmacies. Students are encouraged to choose sites that are outside of Port Elizabeth. Warning! Placements at Pharmacies in Central, Humewood, Summerstrand and Walmer are often requested by a large number of students. If you choose a site within these areas, an alternative site outside of these areas must also be provided.
PHARMACY OPTION 1: Pharmacy Name:
Pharmacy Address:
Pharmacy Tel. No.:
Name of Pharmacist/Preceptor:
Placement discussed with Pharmacist:
PHARMACY OPTION 2: Pharmacy Name:
Pharmacy Address:
Pharmacy Tel. No.:
Name of Pharmacist/Preceptor:
Placement discussed with Pharmacist:

POPIA information:

The Protection of Personal Information Act, 2013 (POPI Act) has been promulgated and implemented on 1 July 2020. All personal identifiable information provided by you shall be treated in accordance with this statute and only used for academic and academic administration purposes, as indicated in the University’s Privacy Policy. By providing your information, you are giving consent for the use of all your personal identifiable information, provided to the University, for the aforesaid purposes.