Internship II – 24 Weeks
All the blank spaces must be filled in legibly (in block letters).
I agree that the student of the Faculty of Pharmacy of the University of Veterinary and Pharmaceutical Sciences
Brno mentioned below will perform (part of) his/her Internship II – 24 Weeks in the pharmacy in the stated term:
Name: Surname:
Personal number of the student:
Name of the pharmacy:
Type of the pharmacy (public pharmacy / hospital pharmacy):
Address of the pharmacy (street, city): Country:
Telephone / fax: E-mail:
Working practice from: to:
Number of practice's weeks:
Pharmacy's employee (pharmacist - advisor) in charge of the student's practice:
Personal data protection: All personal data listed in the Paper of Acceptation are treated according to the General Data Protection Regulation (GDPR) (EU) 2016/679.
Pharmacists in question agree with the processing of their personal data necessary for the performance of the student’s professional pharmacy experience.
The appointed data will not be kept longer than necessary, with the time limit being five years after the completion of the Master’s Degree Study.
Date: Signature of pharmacist - advisor
Official stamp of the pharmacy
Guarantor of Internship II – 24 Weeks , Faculty of Pharmacy VFU Brno:
PharmDr. Bc. Dana Mazánková, Ph.D., e-mail: mazankovad@vfu.cz
THE PAPER OF ACCEPTATION
Pharmacy practice (FASM1 Internship II – 24 Weeks ) of the students of the Master Degree
of Pharmacy of the Faculty of Pharmacy at the University of Veterinary and Pharmaceutical Sciences Brno