Pharmacy Technology. Application Package January 2012

Pharmacy Technology

Application Package

January 2012

3000 Campus Hill Drive

Livermore, CA 94551

925-424-1354

Las Positas College

Pharmacy Technology Program

Application Package

Las Positas College’s Pharmacy Technology program is a 32-week training program that qualifies graduates to become a licensed Pharmacy Technician in the state of California.

Program Location: Las Positas College, Building 2400 Program Dates: January 17th through June 7th (lecture & laboratory); June 8th through August 19th (externship)

Program Times: Monday - Thursday from 6:30pm - 9:30pm Program Fees: $3200* **Recommended Coursework: • English • Mathematics • Biology or Anatomy/Physiology • Medical Terminology

Students are strongly recommended to have taken the above coursework at a college level or have met an equivalency. **Coursework may be taken concurrently with the Pharmacy Technology program.

Certificate of Completion

Upon completion of the program, students will earn a certificate of completion in pharmacy technology.

Completion of the Pharmacy Technology program complies with the required training requirements needed towards an application for licensure by the California State Board of Pharmacy meeting Section 1793.6 (c) of Title 16 of the California Code of Regulations.

To be eligible for the Pharmacy Technology Program, applicants must:

• Be 18 years of age or older.

• Submit a copies verifying high school graduation or GED certification (state requirement for licensure). • Submit copies of high school or college transcripts

documenting the completion of the recommended coursework identified above.

• Be available for 21-weeks of lecture and laboratory instruction Mondays through Thursdays from 6:30pm to 9:30pm.

• Be available for an externship (360 Hours Minimum) in a pharmacy setting.

• Submit a completed the Las Positas College

Pharmacy Technology Program application package. • If applicable, have foreign transcripts evaluated by a

recognized evaluation service firm such as the International Education Research Foundation

http://www.ierf.org to show U.S. equivalency of completion of the recommended coursework.

Upon acceptance to the Pharmacy Technology

program, the following information will be provided in a program packet for follow up:

• Background/Criminal Check • Drug Screening

• TB clearance (2-step TB test)

The packet must be completed and returned within 30 days of acceptance. Failure to return packet may jeopardize enrollment in the program. The processing fee is included within the enrollment fees for the program.

Application Process

Applications are due November 1, 2011 with notification of acceptance provided to students by November 8, 2011. A completed application and copies of transcripts must be

MAILED in a sealed envelope to:

Las Positas College Mailbox 431

3000 Campus Hill Drive Livermore, CA 94551

Upon acceptance into the program, final payment is due by 11/18/11 – No Exceptions. See refund policy below. Contact: For additional information or application

questions prior to submission please email

[email protected] or visit the website at: www.laspositascollege.edu/healthsciences. Applicants are admitted to the program from the applicant pool in this order:

Considered First: Those applicants with completed

applications submitted by November 1st that show they have completed all recommended coursework and eligibility requirements.

Considered Next: Based on availability, additional

applications will be considered for candidates who have not met all recommended coursework and eligibility requirements.

Not Accepted: Those applicants failing to provide proof

of high school graduation or GED certificate.

Note: If more qualified applicants apply than the Program is able to accept, candidates will be chosen by a random selection method.

*Program Fees: $3,200 includes instruction, textbooks, laboratory equipment, supplies & materials, background

check, drug testing, TB testing, and uniforms. Refund Policy: Students may withdraw from the program prior to

LAS POSITAS COLLEGE – PHARMACY TECHNOLOGY PROGRAM

APPLICATION PACKAGE

 Completed Pharmacy Technology Application.

 Copies of high school transcript or proof of high school graduation or GED certificate.

 Copies of high school or college transcripts documenting the completion of the recommended coursework.

PART A: Personal Information

Last Name First Name Middle Initial

Social Security Number (required for CA Board of

Pharmacy registration)

Date of Birth:

_____________________

Are you currently active military or a Veteran of the armed forces?

o

o

Are you currently receiving unemployment benefits?

o

o

Are you registered with the Tri-Valley OneStop?

o

o

Email Address: _______________________________________

Current Home Address:

_______________________________________________________________________ City: ______________________ State: _________ Zip Code: ________________ Is this also your mailing address: Yes _____. If No, please indicate your address below: _______________________________________________________________________ City: ______________________ State: __________ Zip Code: _______________

Contact Number (Please indicate by checking the box below the best contact number)

Home: Cell: Work:

Have you graduated high school in the US? Yes: No:

If no, have you received a GED? Yes: No:

Have you ever been convicted of a felony?

Yes: No: Are you willing to submit to a criminal justice

Part B: General Education Background

Indicate the highest level of education you have completed:

High School: School name: _________________ Diploma : or GED _________________ Year: _________________ Community College: School name: _________________ Degree: _________________ Year: _________________ University: School name: _________________ Degree: _________________ Year: _________________ Graduate School: School name: _________________ Degree: _________________ Year: _________________

Required Content Knowledge:

Please indicate your prior knowledge/level of competency in the following content areas.

(Include copies of transcripts with application package)

Subject Matter High School AP Course Name College Course Name Grade Received Year Mathematics English Biology or Anatomy/Physiology Medical Terminology

Technical Standards Yes No

Are you able to stand for 65-100% of work hours? Are you able to walk 65-100% of work hours?

Are you able to lift 20lbs for 50% - 100% of work hours? Are you able to lift 20-40lbs for 25-50% of work hours? Are you able to bend 1-33% of work time?

Are you able to reach above your shoulder level intermittently for 90% of your work time?

Please rate your typing skills as

Personal Information: Please describe briefly your background or employment history and interest in the pharmacy technician certificate program. You may use a separate page for this essay however you must sign this form and return with your application.

I certify that the statements and information in this application are true and complete to the best of my knowledge. _____________________________________________ ______________________

Applicant Signature Date

Background Screening Policy:

Students may not be able to attend clinical facilities with a record of felonies and some misdemeanors

in their background check. Students may be denied placement in an externship based on such offenses

appearing on a criminal report. Las Positas College is not responsible for the accuracy of the screening.

Students must be willing to share the results of the background screening with a prospective clinical

externship site. A site may, upon review of the report, determine that a student does not meet security

standards. Las Positas College is not obligated to make special accommodations for these students and

will not seek alternative sites if there is a problem with the applicant’s background screening. If a student

is unable to be placed, they would not satisfy the requirements for completing the pharmacy technician

certificate program.

I have read the above statement, and I understand that the background screening can impact my placement

in a clinical site. Failure to complete a clinical externship would prevent successful completion of the

certificate program and subsequently affect any application for state licensing.

_____________________________________________

Applicant Signature Date

FOR OFFICIAL USE ONLY:

RECEIVED BY: _______________________________________________________________________________

Name Date Time