Pharmacotherapy Chapter_The Saudi Critical Care Society (SCCS)

Delegates Registration Form

Thank you for considering to apply to the pharmacotherapy chapter delegates program. The program is intended to help junior pharmacists develop their soft and clinical skills while serving the profession. This program has two main pillars the pharmacy profession service and professional development. The delegates are offered an opportunity to make professional connections, be immersed in the chapter services and events. In this program, delegates will refine their interpersonal, interprofessional, leadership, and teamwork skills, make connections with others, and expand their commitment to volunteerism. Recruited junior pharmacists can be students, recent graduates, pharmacists, or pharmacy residents who can be involved in various initiatives supporting the pharmacy profession, education, research, service, and networking.
1.Applicant name(Required.)
2.Gender(Required.)
3.Email(Required.)
4.Age(Required.)
5.Mobile number(Required.)
6.Applicant level(Required.)
7.Year of graduation from pharmacy school/ expected year of graduation from pharmacy school(Required.)
8.Institution Affiliation (School or work place)(Required.)
9.Residence city(Required.)
10.Why are you interested to join the program?(Required.)
11.What do you expect to gain by the end of this program?(Required.)
12.What would you add/bring to the board delegates program?
13.Please rate yourself in the following skills(Required.)
Beginner
Proficient
Expert
 Communication skills
Teamwork skills
Public speaking
Leadership and organization skills
14.In which of the following responsibilities do you find yourself(Required.)
15.I herby understand by submitting the request for delegate program at the Pharmacotherapy Chapter at SCCS and I am ready to commit to the program(Required.)
Current Progress,
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