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Request for the Release of AFCP Passport Cards
for Staff Members, Students, and Volunteers of CSDM
Date of Birth of Applicant
Year
Month
Day
The Card Holder Has an:
What is the Designation of the Card Holder at CSDM?
Pharmacist
APA Pharmacist
Pharmacist Assistant Trainee (ALWAYS TEMPORARY)
Pharmacy Volunteers (ALWAYS TEMPORARY)
Special Authorization from Pharmacy Manager
Has a FAMA-enhanced BGC been completed for this individual?
YES
NO

Be aware that for each request this information will be verified remotely. If a FAMA-enhanced check has not been performed, the card will not be issued.

I am requesting a
Who is authorizing the release of this AFCP Passport Card?
Date of Application
Year
Month
Day
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

You may use your mouse to sign inside the box, or you may choose to upload your signature as a file, or you may choose to type your signature. All three forms are legally accepted in Alberta.

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