SHPA Residency Program – Foundation Resident Registration SHPA Training Programs – Resident Candidate Registration Congratulations on being part of the SHPA Resident Training Program. All Resident candidates must be SHPA members throughout the duration of their program. If you are not an SHPA member, please join first Pharmacists accepted into a Resident Training Program via an accredited site are required to register with SHPA. This is in addition to internal HR processes at your hospital. If you require assistance completing your registration or have any questions regarding the Resident Training Program, please contact residency@shpa.org.au SHPA operates in accordance with the Australian Privacy Principles. For more information about SHPA and our respect for your privacy, see our SHPA Privacy Policy.Your detailsPreferred title:(Required)MrMsMissMrsDrMxFirst name:(Required) Last name:(Required) Email address:(Required) Date of birth:(Required)DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender:(Required) Woman Man Non-binary Other Daytime phone number:(Required)Mobile number:(Required)Address(Required)State and post code only State / Province / Region ZIP / Postal Code Are you an SHPA member?:(Required)All candidates undertaking the SHPA Resident or Registrar Training Program must be SHPA members for the duration of the program. If you are not a member, please join – https://www.shpa.org.au/joinrenew Yes No SHPA member number:(Required) Workplace detailsWorkplace employer:(Required)Name of residency siteAlfred HealthAlice Springs HospitalAustin HealthBarwon HealthBlacktown & Mount Druitt HospitalCairns HospitalCalvary Public Hospital BruceCanberra Hospital and Health ServicesEastern HealthEpic Pharmacy Services (Wesley Hospital)Epic Pharmacy Services (Hollywood Private Hospital)Epic Pharmacy Services (Northern Beaches Hospital)Fiona Stanley HospitalFreemantle HospitalGold Coast HealthGrampians Health BallaratGreenslopes Private HospitalHervey Bay HospitalLatrobe Regional HospitalLaunceston General HospitalLismore Base HospitalLogan HospitalMackay Base HospitalMercy HealthMt Isa HospitalMonash HealthNorthern HealthNorth West Regional Hospital (Tas)Peninsula Health (Frankston Hospital)Prince of Wales Hospital/Royal Hospital for Women/Sydney Children's Hospital RandwickPrincess Alexandra HospitalQueensland Children's HospitalRamsay Pharmacy ServicesRedcliffe HospitalRoyal Brisbane and Women's HospitalRoyal Hobart HospitalRoyal Melbourne HospitalRoyal North Shore HospitalRoyal Perth HospitalSA Pharmacy: CALHNSA Pharmacy: CHSALHNSA Pharmacy: NALHNSA Pharmacy: SALHNSA Pharmacy: WCHNSlade Pharmacy Richmond (Epworth Hospital)St John of God Subiaco HospitalSt Vincent's Hospital MelbourneSunshine Coast University HospitalSydney Local Health District (Concord, RPA and Canterbury Hospitals)Tamworth Rural Referral HospitalThe Prince Charles HospitalThe Townsville HospitalToowoomba Hospital (Darling Downs Hospital and Health Service)WA Country Health ServicesWestern HealthResident Training Program leader name:(Required)Staff member responsible for Resident Training Program Director of Pharmacy/Chief Pharmacist :(Required) Date you started as a resident candidate :(Required)DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Briefly describe the personal and career goals you wish to achieve during your program :Internship detailsIntern year (e.g. 2013 or 2014-15) :(Required) In what pharmacy practice environment did you undertake your intern year? :(Required) Hospital pharmacy Community pharmacy Industry Academia/research Other If last year was not your intern year, in what pharmacy practice environment was your primary employment? :(Required) Hospital pharmacy Community pharmacy Industry Academia/research Not applicable Other Registration informationDate you became a fully registered pharmacist:(Required)DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your AHPRA registration number:(Required)Can be sourced from the AHPRA website: http://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx EducationUniversity where you completed your primary pharmacy degree :(Required) Highest tertiary qualification:(Required)Additional to your primary pharmacy degree e.g. MPharm or write N/A where not applicable CommentsThis field is for validation purposes and should be left unchanged.
