Northampton Community College Fowler Family Southside Center 511 East Third Street
Bethlehem, PA 18015 www.northampton.edu/cbi
Certified Pharmacy Technician
Program Requirements Checklist & Forms
In order to participate in the Certified Pharmacy Technician course, participants must complete all of the following requirements before the last day of class. All documents must be submitted on or before the last day of class.
Please allow at least three weeks prior to the last class day to complete the enrollment requirements. Please use guide below to ensure all requirements are satisfied in a timely manner.
Three weeks prior to last day of class:
• Complete Pennsylvania State Police Background Check.
• Complete FBI background check, ONLY if you have not resided in PA for past two consecutive years. Two weeks prior to the last day of class:
• Complete drug screening test. Information about the drug screen will be sent to participants after enrollment.
Requirements Checklist
Must be at least 18 years of age to attend class.
Enroll in the course. Register online at northampton.edu/lifelearn or by calling 1-877-543-0998. Please reference course code PHARM102 when registering. Course fee is due at the time of registration via credit card.
Completed Student Information Form. High School Diploma or GED
All participants must complete the following requirements prior to the last day of class in order to participate in the externship.
Completed Pennsylvania Criminal Background Check (dated less than one year through class completion date). FBI Clearance must be completed only if you have not resided in PA for the past two consecutive years. Please note: background checks may not contain prohibitive offenses as cited in Act 14. The Act 14 documentation is included in this electronic packet.
Completed drug screen.
Withdrawal & Refund Policy
To withdraw, please go to northampton.edu/LifeLearn, log in and complate a drop request. Withdrawals must be completed five business days prior to the course start date to obtain a full refund. For more information, please visit northampton.edu/NoncreditRefund.
Questions
PHARMACY TECHNICIAN W/EXTERNSHIP TRAINING PROGRAM
Student Information Sheet PLEASE PRINT Name Address City/State/Zip County Phone (H) (C)
*HAVE YOU RESIDED CONTINUOUSLY IN THE STATE OF PENNSYLVANIA FOR THE PAST TWO YEARS?* Yes No
Birthdate MALE FEMALE
E-mail Address
Please check here if we may email you updates about our classes and programs. WHO PAID FOR YOUR PHARMACY TECHNICIAN WITH EXTERNSHIP TRAINING?
Self CareerLink * Other
*Please provide Name, Address, Phone, and Email Information of your Case Manager/Point of Contact: SCHOOL BACKGROUND
1. Are you a high school graduate? Yes No 2. If not a high school graduate, do you have a G.E.D.? Yes No 3. Have you previously attended college? Yes No Degree(s) earned
4. Do you plan to continue your education after this class? Yes No
WORK EXPERIENCE
Are you currently employed? Yes No
Name and location of employer: What is your job title?
MINORITY INFORMATION
The following information is requested to monitor the compliance posture of the institution and will be used only to collect and maintain data on the race, sex, and ethnic identity of all students. This information may be requested on national and state statistical reports. Please check all that apply to you. (OPTIONAL)
American Indian Caucasian Other Asian Hispanic/Latino
Black/African American Native Hawaiian or Other Pacific Islander
FOR OFFICIAL USE ONLY Verification of Residency
PA Background Check Out of State FBI Check Social Security Card Verification of PA Res. Other:
Photo ID (Student ID) Initials:
7/09
HOW TO OBTAIN A PA CRIMINAL BACKGROUND CHECK THROUGH PATCH
The Pennsylvania State Police established a web-based computer application called “Pennsylvania Access to Criminal History” or PATCH. Using this system, a requestor can apply for a criminal background check on an individual basis.
The information provided by the requestor will be checked against the criminal history database
maintained by the Pennsylvania State Police Central Repository. If the subject’s information does not hit on any information in the database, the requestor will receive the results instantly over the Internet and the requestor can print out the “No Record” certificate. Eighty percent of the time, “No Record”
certificates are returned immediately through the Internet to the requestor. If the subject’s information hits on something in the database, the requestor receives an immediate “Request under Review” response.
A “Request under Review” response does not necessarily mean that the individual has a record; it does indicate the information is being manually reviewed. After review, the status will be updated to “No Record” or “Record”. The requestor should check the PATCH website periodically for an updated status of their request.
For all “No Record” responses, the certificate must be printed out at the requestor’s computer. All “Record” responses will be mailed to the requestor at the address provided by the
requestor. It may take up to two weeks for the status to be updated from a “Request under Review” to a “No Record” or “Record”.
TO SUBMIT A NEW RECORD CHECK:
Log onto https://epatch.state.pa.us and select “Submit a New Record Check” under credit card users. The fee for the report is $10.00.
When submitting a new record you must enter personal data including your address, social security, birth date, phone number, etc. You will be asked to verify the data entered on every screen to continue the process.
Do not use spaces when entering your credit card number.
Please note that the PATCH system will not let you proceed unless you enter the requested information correctly and completely.
The screen will ask you to wait until the process is complete then click on the control number to view record. (An example of a control number is #R0712222.) Write down your personal control number in the event you need to go back to the site to check on anything.
The next screen will display the details of a particular record request. To view/print the
certification form for this request, click the CERTIFICATION FORM link. You should see and print a report which has a state seal in the background.
IMPORTANT: WE WILL ONLY ACCEPT THE REPORT WITH THE STATE SEAL IN THE
BACKGROUND. CUSTOMER SERVICE:
Customer service is no longer being handled by the Pennsylvania State Police Help Desk.
Effective immediately, for any questions concerning your criminal background check, the new telephone numbers are: toll free at 1-888-QUERYPA (1-888-783-7972) or (717)425-5546.
Pharmacy Technician with externship Resident Abuse Prevention Training Act 14 of 1997 (P.L. 169) Prohibitive Offenses Contained in 63 P.S. § 675
In no case shall an applicant for enrollment in the Pharmacy Technician with externship training program be approved for admission into such program if the applicant’s criminal history record information indicates the applicant has been convicted of any of the following offenses:
(1) An offense designated as a felony under the act of April 14, 1972 (P.L. 233, No. 64), known as “The Controlled Substance,
Drug, Device and Cosmetic Act.” (See 35 P.S. § 780-101 et seq.)1
(2) An offense under one or more of the following provisions of Title 18 of the Pennsylvania Consolidated Statutes:
(3) A Federal or out-of-State offense similar in nature to those crimes listed under paragraphs (1) and (2) above.
For questions pertaining to codes, offenses, or convictions, contact PA Department of Education at (717) 772-0814 or ra-natcep@pa.gov.
1 These offenses could be designated as “CS” on a criminal rap sheet. 294 (Rev 5/2011, 7/8/2014)
Offense Code Prohibitive Offense Description Type/Grading of Conviction
CC2501 Criminal Homicide Any
CC2502 Murder Any
CC2503 Voluntary Manslaughter Any
CC2504 Involuntary Manslaughter Any
CC2505 Causing or Aiding Suicide Any
CC2506 Drug Delivery Resulting in Death Any
CC2507 Criminal Homicide of Law Enforcement Officer Any
CC2702 Aggravated Assault Any
CC2901 Kidnapping Any
CC2902 Unlawful Restraint Any
CC3121 Rape Any
CC3122.1 Statutory Sexual Assault Any
CC3123 Involuntary Deviate Sexual Intercourse Any
CC3124.1 Sexual Assault Any
CC3125 Aggravated Indecent Assault Any
CC3126 Indecent Assault Any
CC3127 Indecent Exposure Any
CC3301 Arson and Related Offenses Any
CC3502 Burglary Any
CC3701 Robbery Any
CC3901 Theft 1 Felony or 2 Misdemeanors
CC3921 Theft by Unlawful Taking 1 Felony or 2 Misdemeanors
CC3922 Theft by Deception 1 Felony or 2 Misdemeanors
CC3923 Theft by Extortion 1 Felony or 2 Misdemeanors
CC3924 Theft by Property Lost 1 Felony or 2 Misdemeanors
CC3925 Receiving Stolen Property 1 Felony or 2 Misdemeanors
CC3926 Theft of Services 1 Felony or 2 Misdemeanors
CC3927 Theft by Failure to Deposit 1 Felony or 2 Misdemeanors CC3928 Unauthorized Use of a Motor Vehicle 1 Felony or 2 Misdemeanors
CC3929 Retail Theft 1 Felony or 2 Misdemeanors
CC3929.1 Library Theft 1 Felony or 2 Misdemeanors
CC3929.2 Unlawful Possession of Retail or Library Theft Instruments --- 2 Misdemeanors
CC3929.3 Organized Retail Theft 1 Felony or 2 Misdemeanors
CC3930 Theft of Trade Secrets 1 Felony or 2 Misdemeanors
CC3931 Theft of Unpublished Dramas or Musicals 1 Felony or 2 Misdemeanors CC3932 Theft of Leased Properties 1 Felony or 2 Misdemeanors CC3934 Theft From a Motor Vehicle 1 Felony or 2 Misdemeanors
CC4101 Forgery Any
CC4114 Securing Execution of Document by Deception Any
CC4302 Incest Any
CC4303 Concealing Death of a Child Any
CC4304 Endangering Welfare of a Child Any
CC4305 Dealing in Infant Children Any
CC4952 Intimidation of Witnesses or Victims Any
CC4953 Retaliation Against Witness or Victim Any
CC5902B Promoting Prostitution Felony
CC5903C or D Obscene and Other Sexual Materials and Performances Any
CC6301 Corruption of Minors Any
CC6312 Sexual Abuse of Children Any
A n y (1 ) F or ( 2) M ’s w it h in t h e 3900 S er ie s ( C C 3901 -C C 3 934)
FBI CRIMINAL BACKGROUND CHECKS FOR NON-CREDIT STUDENTS NORTHAMPTON COMMUNITY COLLEGE
Northampton Community College, CBI – Healthcare Education now requires Federal Bureau of Investigation (FBI) criminal background checks for all students requesting admittance to the Pharmacy Technician with externship program who have not resided in Pennsylvania for the past two consecutive years. The fingerprint-based background check is a multiple-step process. Prior to beginning the program, the following will need to be completed by the student:
1. The applicant must register prior to going to the fingerprint site. Walk in service without prior registration will not be provided at any fingerprinting location. Registration is available online 24 hours/day, seven days per week at www.pa.cogentid.com. Applicant must select “Department of Public Welfare (DPW)”, then “Register on-line”.
2. Telephonic registration is available at 1-888-439-2486 Monday through Friday, 8am to 6pm EST. During the registration process, all demographic data for the applicant is collected (name, address, SSN, etc.). There is no data entry required at the fingerprint collection site.
3. The applicant will pay a fee of $36.00 for the fingerprint service and to secure the Criminal History Record. Applicants may make their payment online at www.pa.cogentid.com using a credit card or debit card. Money orders or cashiers checks payable to Cogent Systems will be accepted on site for those applicants who do not have the means to pay electronically. No cash transactions or personal checks are allowed. Fee: $36.00. Northampton Community College does not reimburse this fee.
Money orders are made payable to Cogent Systems.
No cash, personal or business checks are accepted at print locations. Payment may be made online at www.pa.cogentid.com.
When registering on-line, for Payment Type, select either Applicant Credit Card or Applicant Money Order. Required fields will be highlighted in yellow with an asterisk and must be completed. Because of NCC providing healthcare education for healthcare providers serving all ages, please select “Employment with a significant likelihood of regular contact with children” for Reason for Fingerprinting. If paying by credit card, be sure to print out a copy of the on-line receipt of payment to take to the fingerprinting site to verify that payment was made.
4. The applicant proceeds to the fingerprint site of their choice for fingerprinting. The location of the fingerprint sites and days and hours of operation for each site will be posted on Cogent Systems’ website at
www.pa.cogentid.com. The location of fingerprint sites may change over time so applicants are encouraged to
confirm the site location nearest to their location.
5. The fingerprint transaction begins when the fingerprinting site reviews the applicant’s qualified State or Federal photo ID before processing the applicant’s transaction. A list of approved ID types may be found on the Cogent Systems’ website at www.pa.cogentid.com. Applicants will not be processed if they cannot produce an acceptable photo ID.
6. After the identity of the applicant has been established, all ten fingers are scanned to complete the process. The entire fingerprint capture process should take no more than three to five minutes.
7. The applicant’s scanned fingerprints will be electronically transmitted to the FBI as required by federal statute. 8. Pennsylvania Department of Public Welfare (DPW) will receive the FBI Criminal History Record from the FBI.
DPW’s Background Check Unit through ChildLine and Abuse Registry will return the FBI Criminal History Record to the applicant. The Record will be printed on standard 8.5” X 11” paper that when copied will reveal “Void if Copied.”
9. The applicant will then provide the original FBI Criminal History Record via mail or hand delivery to the
Program Director’s office by the due date given. Please plan accordingly and allow at least 10 -14 days prior
to the date your paperwork is duefor FBI Criminal History Record to be processed. Student will not be eligible
