Application > Parkinson's Disease Pharmacotherapy Traineeship

Traineeships

To submit the Traineeship Application electronically please fill out the form below and click the submit button. The information you fill out will be sent to your email address. You will then need to forward this email to info@ascpfoundation.org and attach your additional required documents (Exhibits) to it.

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SESSION PREFERENCE: Preferences will be taken into consideration, but cannot be guaranteed. Submission of an application indicates an ability to attend either traineeship session. (Selection required.)

July 26-30

November 1-5

No preference

ADDITIONAL APPLICATION DOCUMENTS REQUIRED:

The following items of information are to be appended to this form, each clearly labeled in the upper right-hand corner, as indicated (Exhibit A, Exhibit B, Exhibit C):

Exhibit A. Curriculum vitae, including the applicant's education, experience record in pharmacy practice (in reverse chronological order, most recent first), and any relevant publications, presentations, and community service.

Exhibit B. A statement of not more than three typed, double-spaced pages describing (1) why the applicant wants to participate in the traineeship and the applicant's expectations of the traineeship experience; (2) nature and extent of professional or personal involvement with persons with Parkinson's disease and other neurological disorders, caregivers, or family members; (3) current level of clinical services provided by the applicant, including total number of patients served, geographic distribution (urban, rural, suburban), ethnic distribution (Black, White, Hispanic, Asian/Pacific Islander, American Indian/Eskimo/Aleut), and number of patients with Parkinson's disease; (4) special services or programs provided by the applicant; (5) how the traineeship will enhance the pharmacy services currently provided; and (6) how the results of the traineeship experience will be incorporated into the applicant's practice.

Exhibit C*. A letter from the applicant's employer confirming support for the applicant's participation in the traineeship and willingness to implement the results of the traineeship. The letter should be addressed to the applicant and signed by the chief executive officer, director of pharmacy, clinical coordinator, or other appropriate manager/supervisor in the organization.

*If the applicant is self-employed, this exhibit may be omitted.

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I certify that the information I have submitted in this application and the accompanying exhibits are complete and correct to the best of my knowledge and belief.

Applicant Signature:

(Type if submitting electronically)

Date:

Deadline for Receipt of Applications: MAY 14, 2010