Application for FFPM

FPM Examiner Application Form
Thank you for your interest in becoming an Examiner for FPM.

Before you start, please click through the tabs above to read about eligibility and the information needed to fill in this form.

You can save this form at any point and return to it. A link will be sent to the e-mail address you have entered below.
Full name*

TitleFirst nameLast name
Your membership number (if known)
Your GMC (or equivalent) registration number
Email address*
Contact phone number*
Area of specialty (clin dev/med affairs/etc)
The Faculty of Pharmaceutical Medicine (FPM) processes your personal data in connection with your application for Fellowship of FPM following the principles of the Data Protection Act 2018. The information you provide in this application will be shared with members of FPM's Officers of the Board of Examiners. Any other sharing of information will only take place with your consent or if FPM has a lawful basis to do so.

Eligibility
A potential Examiner must satisfy the eligibility criteria below and confirm that they can commit to performing the role.
About you (you must select all options)*

I can attend the forthcoming Examiners' Training DayI am a Member (MFPM) / Fellow (FFPM)I am registered and in good standing with the GMCI have submitted my CVI have the support of a referee
Your role (select one)*

I am actively involved in an aspect of pharmaceutical medicineI fall into one of the exemption categories listed below*
Eligible to apply*

I confirm that I am eligible to apply to become an Examiner and can commit to performing the role (see Notes below)
Signature of applicant (use the cursor to sign your name)*

Clear
Notes

A potential Examiner in pharmaceutical medicine must:
- Be an FPM Member or Fellow;
- Be registered and in good standing with the GMC;
- Have active involvement in any aspect of pharmaceutical medicine,
- or fall into one of the exemption categories listed below*
* Exception of these requirements for:
- Members or Fellows of one of the Medical Royal Colleges of the United Kingdom and/or individuals of equivalent seniority in other disciplines who have relevant expertise in pharmaceutical medicine or examinations and are invited by FPM’s Education & Standards Committee (ESC) to participate in the activities of the Board of Examiners.
- International Examiners who hold full medical registration in another country (with entry on the specialist register/GP register where appropriate) and without limitation on their practice.
For more information on the on-going commitment of being an Examiner, see FPM Board of Examiners webpage.

Curriculum vitae
Upload your CV *

Browse Files
A full CV must be submitted. Cancelof

Statement of Support
You are required to provide a statement of support from a referee*. Please ask your referee complete the Statement of Support form.
Name of supporting referee*

First NameLast Name
Email of supporting referee*
example@example.com
I confirm I have contacted the named referee and they have agreed to support my application*

Yes
*Your referee must:
- Have a relevant professional connection with you e.g. a current or former manager, co-worker, ES or SA
- Be medically qualified and a Member/Fellow of FPM and/or a member of the Board of Examiners

Submitting your application

Thank you for applying to become an Examiner for FPM. You will receive a pdf copy of this application by email when you submit it.

You must:

1 - Send the copy of your applicaition to your referee (they need to see it before they can confirm their support for you).

2 - Ask your referee to complete the Statement of Support form.
Should be Empty:

FPM Examiner Application Form

Eligibility

Notes

Curriculum vitae

Statement of Support

Submitting your application