Pharmacy Technology. Application Package January 2012

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1 Pharmacy Technology Application Package January Campus Hill Drive Livermore, CA

2 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 17 th through June 7 th (lecture & laboratory); June 8 th through August 19 th (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 (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 to show U.S. equivalency of completion of the recommended coursework. Application Process Applications are due November 1, 2011 with notification of acceptance provided to students by November 8, A completed application and copies of transcripts must be MAILED in a sealed envelope to: Las Positas College Mailbox Campus Hill Drive Livermore, CA 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 or visit the website at: 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. 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. *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 the 4th class session and receive a refund of their enrollment fee excluding $1000 for the Textbooks, Background /Criminal Check, Drug Screening, TB Clearance, and Administrative Fee. After the 4th class, there will be no refunds.

3 LAS POSITAS COLLEGE PHARMACY TECHNOLOGY PROGRAM APPLICATION PACKAGE Application Package Check List: 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 Yes o No Are you currently receiving unemployment benefits? o Yes o No Are you registered with the Tri-Valley OneStop? o Yes o No 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? If no, have you received a GED? Yes: No: Yes: No: Have you ever been convicted of a felony? Yes: No: Are you willing to submit to a criminal justice background screening? Yes: No:

4 Part B: General Education Background Indicate the highest level of education you have completed: High School: Community College: University: Graduate School: Diploma : or GED Required Content Knowledge: Please indicate your prior knowledge/level of competency in the following content areas. (Include copies of transcripts with application package) Mathematics Subject Matter High School AP Course Name College Course Name Grade Received Year English Biology or Anatomy/Physiology Medical Terminology Technical Standards Yes No Are you able to stand for % of work hours? Are you able to walk % 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 one of the following: Good: > 35 wpm Fair: wpm Poor: < 35 wpm

5 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 Application Status: / Accepted Declined

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