System Wide Bid for Cross Sector PTPTs

1. Name of organisation

2. What area does your organisation fall under

Secondary Care
Primary Care
Community
Other (please specify):

3. Name of lead person (forename and surname)

4. Contact details of lead person (email and contact number)

5. How many pharmacy technicians do you intend to employ? Please put an 'X' in the appropriate box/es

	1	2	3	4
Recruit new	Recruit new 1	Recruit new 2	Recruit new 3	Recruit new 4
Upskill existing	Upskill existing 1	Upskill existing 2	Upskill existing 3	Upskill existing 4
Unsure	Unsure 1	Unsure 2	Unsure 3	Unsure 4

Other amount: please specify

6. Please note the names of the existing staff you hope to upskill

7. If recruiting new apprentices, please indicate what support you might need:

8. Do you have a registered pharmacy professional/s available in your organisation to undertake educational supervision for the apprentices?

Yes
No
If yes, please note their name/s and job title

9. Is there any support you feel you would need from us?

10. Do you have any further questions?

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