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Thank you for choosing to study MPharm Pharmacy at UCLan. We are pleased to invite you to take part in a telephone interview. We have included several documents in this guide to help you prepare for your interview, these include; Interview Instructions – please read carefully to prepare for your interview. Online course presentation - we have put together an audio-visual presentation

which you can watch before your interview. FTP form for Pharmacy – please complete this form and email to

FosterHub@uclan.ac.uk using a subject title of "MPharm Interview Day Forms – NAME – UCAS ID”. You should send this at least 2 days before your interview takes place.

Declaration form - please complete this form and email to FosterHub@uclan.ac.uk using a subject title of "MPharm Interview Day Forms – NAME – UCAS ID”. You should send this at least 2 days before your interview takes place.

Communication & Dress Code

Instructions to applicants

For your interview:

• Please have a pen and paper ready;

• Please have a calculator ready;

• Please have this information sheet in front of you;

• You do not need to prepare anything; the interviewer will guide you

through this information during your interview

1 50 mg, 5 mL

2 3 × 10-7 m

3 £5.00, £5.25

4 2.5 L, 1240 mL, 0.8 L

5 40 mg/kg

We have put together an audio visual presentation which you can watch by clicking on the link below.

OPEN

Applicant/Student Name: ……………………………………… Applicant/Student ID: G ………………………………………..

University of Central Lancashire

School of Pharmacy and Biomedical Sciences

Fitness to Practise Form

Degree of MPharm ("the Course")

If you are applying for a place on the Course – Please complete Part A of this Form

If you are a student re-enrolling for a new academic year – Please complete Part B of this Form

Please note:

(a) This Form and the declaration hereby given are part of the School of Pharmacy and BiomedicalScience's processes to ensure that all students either studying on the Course or applying tostudy on the Course, meet the student fitness to practise requirements for pharmacists, laiddown by the General Pharmaceutical Council (GPhC). Any information given in this Form willbe treated in the strictest confidence.

(b) You must answer all questions on this Form truthfully and accurately to the best of yourknowledge and belief. A declaration will not necessarily prevent you from being admitted to theCourse and the School will make an informed and considered judgement in each individualcase. If you have any queries, please ask a member of staff.

(New Applicants)

(c) If you are an applicant applying for a place to study on the Course your offer is conditional uponclearance of your suitability to practise pharmacy based on the information contained in thisForm and on any information provided to us by the Disclosure and Barring Service (DBS) as aresult of an enhanced DBS check. The information you provide on this form will be checkedagainst your DBS disclosures. If the information proves to be incorrect your offer of a placemay be withdrawn. Please see appendix 1 for advice about what must be declared,

(Progressing Students and First Year Students)

(d) If you are an existing student your continued study on the Course is conditional upon therebeing no change to your health or good character which might call into question your fitness topractise. If the information you provide in this Form proves to be incorrect this may result in thetermination of your professional training. Additionally, if any declaration(s) made by you raisequestions about your fitness to practise these will need to be considered under the University’sFitness to Practise Procedure.

Note that the School of Pharmacy and Biomedical Sciences is making a judgement as to your suitability for admission to and continued study on the MPharm (Hons), the General Pharmaceutical Council (GPhC) alone is responsible for making decisions on a person’s admission for preregistration pharmacy training. GPhC documentation will need to be completed at the appropriate time.

Please complete this form and email to FosterHub@uclan.ac.uk using a subject title of "MPharm Interview Day Forms – NAME – UCAS ID”.You should send this at least 2 days before your interview takes place.

PART A (To be completed only by applicants wishing to apply for a place on the Course)

Section 1 Personal Details

1.1 Name 1.2 Any former name(s) (first/surnames)

Section 2 Fitness to Practise proceedings with other regulatory bodies

2.1 Have you ever had a finding made against you by a regulatory body or are you currently being investigated by a regulatory

body?

Please appropriate box Yes No

If the answer to the above question is 'Yes' please complete Part C, Section 1.

Section 3 Criminal proceedings

3.1 IMPORTANT: Please refer to Appendix 1 for details of those cautions or convictions which must be disclosed.

Have you been charged with or found guilty of a criminal offence either in this country or in any other country or received a conviction, caution, reprimand or final warning? Are any criminal proceedings against you currently in progress or are you currently being investigated in respect of a criminal offence?

Please appropriate box Yes No

If the answer to the above question is 'Yes' please complete Part C, Section 2.

Section 4 Health

4.1 Have you at any time received a formal diagnosis of a physical or mental health condition, including dyslexia and

dyscalculia?

Please appropriate box Yes No

4.2 Do you have a history of substance dependence?

Please appropriate box Yes No

If the answer to the above questions is 'Yes' please complete Part C, Section 3.

Section 5 Declaration & Consent

5.1 I declare that the information given on this Form and on any supplemental sheets or in supporting documents is true and

accurate to the best of my knowledge and belief; and

5.2 I hereby agree to notify the University if at any time prior to enrolment on the Course any of the above information

changes; and

5.3 I hereby give my consent for personal information provided as part of this declaration to be held on computer or in other

relevant filing systems for the duration of the Course and a further two years following completion of the same 5.4 To the extent (if at all) that I have disclosed any relevant information in Part C of this Form I hereby authorise the

University to disclose this information to any relevant parties in relation to any placements in which I may take part during the Course.

Signature Date

PART B (To be completed by existing students re-enrolling for 2nd/3rd/4th year study, or 1st year students who completed a Fitness to Practice Form on application)

Section 1 Personal Details

1.1 Name 1.2 Any former name(s) (first/surnames) 1.3 Student number

Section 2 Fitness to Practise proceedings with other regulatory bodies

2.1 Since the date of your last declaration have you had a finding made against you by a regulatory body or are you currently

being investigated by a regulatory body?

Please appropriate box Yes No

If the answer to the above question is 'Yes' please complete Part C, Section 1.

Section 3 Criminal proceedings

3.1 Since the date of your last declaration have you been charged with or found guilty of any criminal offence either in this

country or in any other country or received a police caution or been made subject to any bind -over or conditional discharge or equivalent? Are any criminal proceedings against you currently in progress or are you currently being investigated in respect of a criminal offence?

Please appropriate box Yes No

If the answer to the above question is 'Yes' please complete Part C, Section 2.

Section 4 Health

4.1 Since the date of your last declaration have you had any formal diagnosis of a physical or mental health condition, or

suffered any deterioration in an already disclosed condition, or become substance dependent?

Please appropriate box Yes No

If the answer to the above question is 'Yes' please complete Part C, Section 3.

Section 5 Declaration & Consent

5.1 I declare that the information given on this Form and on any supplemental sheets or in supporting documents is true and

accurate to the best of my knowledge and belief; and

5.2 I hereby agree to notify the School if during the coming academic year the above information changes; and

5.3 I hereby give my consent for personal information provided as part of this declaration to be held on computer or other

relevant filing systems for the duration of the Course and a further two years following completion of the same. 5.4 To the extent (if at all) that I have disclosed any relevant information in Part C of this Form I hereby authorise the

University to disclose this information to any relevant parties in relation to any placements in which I may take part during the Course.

G

Signature Date

PART C

Section 1 Fitness to practise proceedings with other regulatory bodies

1.1 Name of regulatory body 1.2 Date on which the finding was made against you / / 1.3 Details of the finding made against you.

Continue on a separate sheet if necessary.

1.4 Provide any further information about the finding or allegations made against you, that you wish us to know about.

Continue on a separate sheet if necessary.

1.5 List any supporting documents you have included with this form, for instance a copy of the charges/

allegations and/or the findings against you.

Continued overleaf

Section 2 Criminal Proceedings

2.1 Name and type of offence 2.2 Date of offence / / 2.3 For convictions provide the name and address of the court where you were convicted. For cautions provide the name of

the charging officer and address of police station where you received the caution.

2.4 Provide a description of the circumstances of offence. This should include the time and location of the offence, your

relationship to those involved (if relevant) and any mitigating factors. Continue on a separate sheet if necessary.

2.5 Provide any further information about the offence that you wish us to know about. This may include any steps you have

taken to rehabilitate yourself after the offence or any insight you have into the nature of the offence. Continue on a separate sheet if necessary.

2.6 Please note that you will be asked to provide supporting documents, for instance your certificate of conviction or caution.

Please ensure that the information you provide on this form is full and accurate as it will be cross-checked against your DBS disclosure.

Continued overleaf

Section 3 Health

3.1 Description of your condition.

3.2 The date of the initial diagnosis and subsequent history (for instance is the condition currently active or relapsing).

3.3 How do you manage your condition?

3.4 If you have declared a history of substance dependency, please state what substances were involved, the circumstances

surrounding the substance dependency, any medical treatment or support you received or are receiving, and how you manage the condition alongside your day to day activities?

3.5 Please provide contact details for your General Practitioner (GP) or other health professional who know about

your physical or mental health condition or history of substance dependence (see overleaf).

Health report consent form We may need to ask for a health report about you from your General Practitioner (GP) or any other health professional who knows about your physical or mental impairment or health condition. Please provide details of your GP and/or hospital consultant

Name of health professional

Surgery/Hospital Name

Address

Telephone number

Email address

Name of health professional

Surgery/Hospital Name

Address

Telephone number

Email address

Please note, Information disclosed within this declaration will be used to assess your suitability to study on the MPharm (Hons) only, and will NOT be shared with other areas of the organisation. You will need to ensure that you have made arrangements to inform the University, in particular the Disability Advisory Service, of your circumstances where you require further advice or assessment for provision of support. Declaration and Consent I hereby give my consent for the School to contact the above named health professional and for such information to be shared with the Suitability Panel. I also consent to attending any necessary appointments that may be arranged to assess my suitability for admission to the MPharm (Hons). Signature: Date:

APPENDIX 1

Disclosure of Cautions/Convictions

You are required to declare all convictions, cautions, reprimands and/or final warnings that would be disclosed on

an enhanced Disclosure and Barring Service (DBS) certificate.

New legislation means that certain old and minor cautions and convictions are no longer subject to disclosure

and will be filtered out and will not show on an enhanced DBS certificate.

. Guidance and criteria on the filtering of these cautions and convictions can be found on the Disclosure and

Barring Service (DBS) Website, see: http://www.gov.uk/dbs.he rules as to when a conviction or caution will be

filtered out are set out in legislation. This states that a Disclosure and Barring Service (DBS) certificate must

include the following:

Cautions relating to an offence from a list agreed by Parliament (specified offences)

Cautions given less than 6 years ago (where aged 18 or over at the time of caution)

Cautions given less than 2 years ago (where aged under 18 at the time of caution)

Convictions relating to an offence from a list agreed by parliament (specified offences)

All convictions where there is more than one conviction

Convictions that resulted in a custodial sentence (regardless of whether served)

Convictions given less than 11 years ago (where aged 18 or over at the time of conviction)

Convictions given less than 5.5 years ago (where aged under 18 at the time of conviction)

Aged Under 18 Aged 18+

Caution 2 years 6 years

Conviction 5.5 years 11 years

It is important to note that under these provisions all cautions and convictions for specified serious

violent and sexual offences and other specified offences of relevance for posts concerned with

safeguarding children and vulnerable adults will remain subject to disclosure.

If you wish to obtain further information about whether you should declare your caution/conviction before

submitting your completed Fitness to Practise form, please contact Joanna Robinson in Foster Hub (F58), email

JMRobinson2@uclan.ac.uk . If you wish to make your own enquiries with www.gov.uk/dbs or www.unlock.org.uk

before submitting your form, please note that a decision about your application would be delayed until we

received your completed form.

This information requested is in line with the DBS checks which will be undertaken at enrolment and this will be

checked against the DBS report. If you fail to declare something which is disclosed on the enhanced DBS

Certificate you may be withdrawn from the course. If you do declare something which would not be disclosed on

the enhanced DBS Certificate, the University is obliged to disregard that declaration when considering your

application.

Name of Candidate:

Student to read, circle appropriate answers and sign :

DBS: Since students will be working with patients during their course (e.g. in placements) all students will have to complete a DBS (Disclosure and Barring Service) Application Form at registration and we will require satisfactory clearance. Please note that you are required to declare all convictions, cautions and reprimands and/or final warnings that would be disclosed on an enhanced DBS certificate. This information will only be seen by those who need to see it as part of the recruitment process.

Have you read this DBS statement? Yes / No

Do you have a criminal record? Yes / No

Have you made full disclosure on the Fitness to Practise (FfP) Form? Yes / No

Not declaring something which is subsequently disclosed through a DBS check could result in your removal from the course.

Health: As part of the Fitness to Practise process you are required to declare any health issues. Please note that you must declare any physical or mental health conditions including ADHD, dyslexia, eczema etc.

Have you read this Health statement? Yes / No

Have you made full disclosure on the Fitness to Practise (FfP) Form? Yes / No

Not declaring something which is subsequently disclosed could result in your removal from the course.

Dress Code: The School’s Communications and Dress Code was circulated at registration.

Have you read it? Yes / No

Do you understand and accept it? Yes / No

Placements: Please note that student Placements could be anywhere in the North West.

Do you understand and accept this? Yes / No

Disabilities: Do you have any disabilities that you require help with if you are a successful applicant? Yes / No

Have you disclosed these on the Fitness to Practice form? Yes / Not Applicable

Not declaring something which is subsequently disclosed could result in your removal from the course.

Fitness to Practise database: In the interests of patient and public safety, we wish to share some of the information provided in your application form with the Pharmacy Schools Council in order to verify your fitness to practise. If a fitness to practise outcome is made against you in the future, this information and a copy of the decision against you will also be stored on a central database which is accessible only to other schools with courses leading to entry to a registered profession in the UK. It is used only for proper fitness to practise purposes to protect patients and the public. This offer is conditional on you having disclosed any previous fitness to practise outcomes against you, and your consent being given to this use of information. You have a right of access to any information held about you on the database and to correct any errors. If you wish to exercise the right, please contact your Fitness to Practise lead.

I give my consent for the information provided in my application form to be shared with the Pharmacy Schools Council in order to verify my fitness to practise. Yes / No

Candidate Declaration: I confirm that the information recorded above is complete and correct.

Candidate Signature: ___________________________ Date: ________________

DECLARATION

FORM

Please complete this form and email to FosterHub@uclan.ac.uk using a subject title of "MPharm Interview Day Forms – NAME – UCAS ID”.You should send this at least 2 days before your interview takes place.

Equality & Diversity The University’s Medium Term Strategy (2007 – 2017) makes an explicit commitment to value and practice equality of opportunity, transparency and tolerance with values which seek to create educational opportunity for all and to protect the rights and freedoms of individual and respect diversity. The University aims to be an inclusive community, welcoming all people who support our core values irrespective of their age, ethnic origin, gender, sexual orientation, religious beliefs, political affiliations or disabilities. The Equality and Diversity Policy has the fundamental aim of establishing an integrated community based on mutual respect and tolerance where all staff and students can feel safe, valued and supported. Programmes within the School of Pharmacy and Biomedical Sciences are accredited by the Royal Pharmaceutical Society of Great Britain, leading to registration as a pharmacist, and as such carries responsibilities which may sometimes be in conflict with certain religious beliefs or codes of dress.

Communication & Dress Code The School of Pharmacy and Biomedical Sciences has adopted a dress code policy for students on placements and when attending pharmacy practice taught sessions that is in line with the guidance set out by the General Medical Council (GMC). The GMC states that non-verbal communication is at least as important as verbal communication, and how a student or pharmacist appears to patients means as much as what he or she says. The GMC guidance is that when in a professional setting students must dress in a manner that adds to, and does not detract from, effective communication. The appearance of a student pharmacist is important and should be considered carefully, in general, male and female students should be clean and smartly dressed. Details may be found in the School’s Student Handbook; however, the following are not permitted as they are deemed to be incompatible with effective, sensitive communication:

Wearing a t-shirt with slogans

Wearing baseball caps

Trainers, sandals, open-toed footwear

Visible body art

Excessive body and face jewellery

Revealing clothing

Covering most of the face (this is true not only in clinical settings but also throughout the educational elements of the undergraduate programme, which is built around group work with other students and tutors)

Students must be able to participate fully in communication and other skills training, discussion and assessment. As well as adhering to the dress code, students must be able to interact fully with patients, teachers and examiners of any culture, ethnic background or either gender.

Exams If a student wishes to remain veiled for an examination, a female member of staff must verify her identity immediately before entry into the exam room, sign to confirm this, and escort the student to her seat. The student may then not return to an examination in the event of leaving it unless in exceptional circumstances.

Placements & Visits Students who are on Professional Courses and who have mandatory placements as part of their modules are expected and required to adhere to the mode of dress attire appropriate for their profession. Some institutions, including some NHS trusts, have a dress code, which may not permit the wearing of a full veil.

COMMUNICATION &

DRESS CODE