YAVAPAI COLLEGE PHARMACY TECHNICIAN CERTIFICATE INFORMATION AND ADMISSIONS PACKET SUMMER 2016 Sciences & Health Division Allied Health Department 1100 E. Sheldon Street Prescott, Arizona 86301 928-771-6122 Rev. 7/28/15 1 P a g e
Pharmacy Technician Role in the Pharmacy Pharmacy technicians help licensed pharmacists prepare prescription medications, provide customer service, and perform administrative duties within a variety of practice settings, including community, health-system, and federal pharmacy. They are generally responsible for receiving prescription requests, counting tablets, labeling bottles, maintaining patient profiles, preparing insurance claim forms, and performing administrative functions such as answering phones, stocking shelves, and operating cash registers. Certification Certification is the process by which a non-governmental association or agency grants recognition to an individual who has met predetermined qualifications specified by that association or agency. The PTCE is recognized in all 50 states even though regulations to work as a pharmacy technician vary from state to state. Contact your State Board of Pharmacy for more information. The National Association of Boards of Pharmacy is an additional resource. Wages Pharmacy technician wages are often dependent on experience, qualifications, work environment, geographic location and employer. According to the Bureau of Labor and Statistics (BLS), Occupational Outlook Handbook 2012-13 Edition, the median hourly wage of pharmacy technicians in May 2013 was $14.83. Of pharmacy technicians surveyed, the middle 50% earned between $11.75 and $17.44. The lowest 10% earned less than $9.92, and the highest 10% earned more than $20.78. Job Outlook According to the Bureau of Labor and Statistics (BLS), employment of pharmacy technicians is expected to increase more than 20% by 2022, faster than the average for all occupations. The BLS also suggests that pharmacy technicians with formal education or training, previous work experience, and national certification will be specifically sought after to meet these demands. Employment Resources The American Association of Pharmacy Technicians (AAPT) and the National Pharmacy Technician Association (NPTA) have developed free Career Centers to assist pharmacy technicians in their job search. The Career Centers are available to both job seekers and employers. 1 Pharmacy Technician Certification Board (PTCB) on the Internet at www.ptcb.org 2 P a g e
Mission Statement The mission of the Yavapai College Department of Allied Health is to provide quality education that will develop competent, caring, holistic and ethical practitioners who value lifelong learning and adapt to continuous changes in the health care system. Program Outcomes Upon successful completion of the Pharmacy Technician certificate the student will be able to: Describe the management of client's medical record to include both security and privacy as outlined in HIPAA regulations. Describe and apply effective communication skills essential for the healthcare provider. Identify the relationship between anatomy/physiology, disease states and drugs affecting the respiratory, cardiovascular, renal, nervous, integumentary endocrine, gastrointestinal, reproductive, ENT systems and over-the-counter drugs. Apply technical skills for preparing, dispensing, packaging, labeling drugs; unit-dose dispensing, controlled substance procedures in an inpatient setting and outpatient setting; non-sterile compounding aseptic techniques. Calculate drug dosages, oral, parenteral, pediatric and by body surface area. Program Description The Pharmacy Technician Certificate is a one year program (three consecutive semesters including summers) that prepares students for entry-level positions as pharmacy technicians. The program starts once per year in the summer semester. Acceptance to the program is by application. Students move through the program as a cohort. The program core consists of 20 credit hours. Instructional Delivery Method The pharmacy technician certificate program is offered in a hybrid format. The majority of the course work is done by online delivery with mandatory face to face meetings every semester. Students must be prepared to travel to a variety of clinical sites during the internship. While instructors will try to place students at clinical sites that are close to where they live, there is no guarantee that sites will be available, and students should be prepared to travel to surrounding areas. 3 P a g e
Confidentiality of Student Records The program maintains a file for each applicant and student. The file contains documentation related to admission and progression in the program. Yavapai College Pharmacy Technician program follows the college guidelines for confidentiality of student records as required by the Family Educational Rights and Privacy Act of 1974 (FERPA). Technical Standards This statement of the Technical Standards of the Pharmacy Technician program at Yavapai College identifies the functional abilities deemed essential for students to participate in the program and work in this area. The Technical Standards are reflected in the Pharmacy Technician program s performance-based outcomes, which are the basis for teaching and evaluating all students in the program. Students with disabilities who think they may require accommodation in meeting the Technical Standards of the Pharmacy Technician program should contact the Office of Disability Services to discuss the process of identifying reasonable accommodations. Students should seek accommodation advising as soon as possible so that a plan for accommodation can be in place at the beginning of the program. Applicants seeking admission to the Pharmacy Technician program who may have questions about the Technical Standards and appropriate reasonable accommodations are invited to discuss their questions with the Office of Disability Services. Reasonable accommodation will be directed toward providing an equal educational opportunity for students with disabilities while adhering to the standards of Pharmacy Technician practice for all students. 4 P a g e
Technical Standards The field of Pharmacy Technician requires the following functional abilities with or without reasonable accommodations. Visual acuity Ability to observe, monitor, and/or assess client, and read fine print on monitors, devices, and gauges. Examples of relevant activities: Read written instructions, orders, and prescriptions. Read fine print, monitors and gauges. Acquire information from documents such as computer images, and other modes of delivery. Enter, transcribe, and record information in written or electronic form. See and discriminate between varieties of visual equipment alarms. Able to distinguish shades of color and viscosity. Hearing ability Ability to hear and understand faculty, staff, peers, patient/clients, families, and healthcare workers; interpret conversations; and assess/monitor clients. Examples of relevant activities: Detect audible alarms within the frequency and volume ranges of the sounds generated by mechanical systems that monitor bodily functions. Communicate clearly in telephone conversations. Communicate effectively with patients and with other members of the health services team. Communicate with individuals from a variety of cultural backgrounds. Follow verbal instructions. Olfactory ability- sufficient to assess patients and their environments and implement the services plans that are developed from such assessments. Examples of relevant activities: Detect foul odors of bodily fluids or spoiled foods. Detect smoke from burning materials. Ability to tolerate unpleasant odors related to infections, bad breath, and pharmaceutical agents. 5 P a g e
Mobility-Possess the mobility and strength to stand, walk, bend, stoop, and lift for long periods. Examples of relevant activities: Move quickly from place to place and perform duties in tight spaces. Lift and/or carry 40lbs. to waist level unassisted. Reach above shoulder height and below waist level to manipulate equipment. Stand for extended periods of time. Motor skills (fine and gross)-must be able to perform multiple motor tasks simultaneously. Possess fine and gross motor skills sufficient to handle equipment and provide safe and effective client care; keen sense of touch; steady arm and hand movements. Examples of relevant activities: Perform CPR and other basic life support functions. Operate and manipulate equipment repetitively. Mix pharmaceutical preparations. Manipulate a syringes, needles and small vials to prepare medications. Receive and store supplies. Operate computers and cash registers. Weigh, measure, and count products. Supply and monitor robotic machines. Chart/write in medical records and record patient/client data manually and electronically. Physical endurance sufficient to complete assigned periods of clinical practice. Shifts may vary between 8-12 hours. Ability to speak, comprehend, read, and write English at a level that meets the need for accurate, clear, and effective communication. Handwriting must be legible. Emotional stability to function effectively under stress, to adapt to changing situations, and to follow through on assigned patient services responsibilities. Cognitive ability to collect, analyze, and integrate information and knowledge to make clinical judgments and manage decisions that promote positive patient outcomes 6 P a g e
PHARMACY TECHNICIAN CERTIFICATE Program Sequence Summer 2016 - Spring 2017 Course First Semester- Summer 2016 Credits Hours Pre-requisite PHT 100 Fundamentals of Pharmacy Technology PHT 110 Pharmaceutical Calculations 3 Admission to program. 3 MAT082 or higher or skills assessment. Must take concurrently with PHT100. 2 nd Semester Fall 2016 PHT 120 Pharmacy Practice 4 Prerequisite: PHT110 Must take concurrently with PHT125. PHT 125 Pharmacology 4 Prerequisite: PHT110 Must take concurrently with PHT 120. 3 rd Semester- Spring 2017 PHT200 Pharmacy Tech Certification Review 3 Prerequisite: PHT125 Must take concurrently with AHS296. AHS296 Internship 3 Prerequisite: PHT125. TOTAL CREDIT HOURS 20 Must take concurrently with PHT 200. 7 P a g e
Steps to Apply for Admission Students must meet these requirements in order to apply for the pharmacy technician certificate program: 1. Must be at least 18 years of age by January 1, 2017. 2. Must have a high school diploma or equivalent. 3. Must have a clean criminal background free of misdemeanor or felony convictions; be free of felony or misdemeanor convictions that are drug or pharmacy related. Please refer to the PTCB Candidate Guidebook and Arizona State Board of Pharmacy to determine if you are eligible for certification and licensure in this field: http://www.azpharmacy.gov/ 4. Must have passed the reading proficiency exam at Yavapai College. 5. Must have passed Math 082 (MAT082) or higher, with the grade of C or better, OR skills assessment. 6. Students must apply to and be admitted to Yavapai College prior to applying to the Pharmacy Technician Certificate Program. Please go to www.yc.edu and complete the college admission procedure. Pharmacy Technician Certificate Program applications will be accepted from November 2, 2015 through April 1, 2016. Applications must received by Friday, April 1, 2016. Students will be notified of acceptance to the program by Monday, April 11, 2016 via the email address on their application. Only applications submitted by U.S. mail will be accepted. If you would like confirmation your application has been received, please send your application via certified mail, and request return receipt delivery confirmation. All applications will be considered received as of the date of their postmark. Applications for admissions must include the following: 1. Pharmacy Technician Application for Admission form. This form is provided in packet. 2. All relevant official transcripts of completed pre-entry and post entry General Education courses must be received in the Yavapai College Registrar s office. Official transcripts are sent directly from one Registrar s office to another Registrar s office. Hand carried transcripts are not official transcripts. 8 P a g e
3. Two letters of recommendation-preferably from a current or previous employer or educator. 4. NEGATIVE TB skin test OR a chest X-ray diagnostic report stating no tuberculosis present. Results must not expire during the length of the program. 5. CPR for Healthcare Providers Card. Must not expire during the length of the program. 6. Immunization and Documentation Cover Sheet (see attached) and copies of documents supporting immunization status due no later June 1, 2016. If immunization documentation is not received by June 1, 2016, the applicant will forfeit their admission to the next qualified applicant on the alternate list. Important: Students that forfeit their conditional acceptance or are dropped from the program must reapply at the next application cycle. 7. Five hundred (500) word essay covering content on the Selection Criteria form in this packet. 8. Advisor Pre-Entry Check sheet Form for the Pharmacy Technician Certificate Program. You will receive this form at your appointment with your advisor and your advisor should attach copies of your official transcripts for this application. Please call 928-776-2106 to reach the academic advising department for the Prescott Campus and 928-634-6510 for the Verde Valley Campus. 9. Arizona Department of Public Safety Fingerprint Clearance Card. Fingerprinting is available through the Yavapai College Campus Safety/Police office on the Verde Valley and the Prescott campuses. The Campus Safety/Police office will provide you with a card of your fingerprints and the Arizona DPS Fingerprint Clearance Card application. Students must mail their fingerprints, the application and the required fee to the Department of Public Safety for processing. Processing may take 10-14 weeks. Copies of both sides of the card are required as part of the application. The program will accept a copy of the Fingerprint Card application and a copy of the money order submitted for payment to the Arizona Department of Public Safety with the application until the actual card is received. Acceptance to the program will be conditional until receipt of the actual Fingerprint Clearance card which must be received no later than June 1, 2016 or the applicant will forfeit their admission to the next qualified applicant on the alternate list. Important: Students that forfeit their conditional acceptance or are dropped from the program must reapply at the next application cycle. 9 P a g e
10. There is a $50.00 (fifty) non-refundable application fee due at the time application. Payment must be made at either a Yavapai College cashier/business office or online at yc.edu/radiology by clicking on The Marketplace: Pay Pharmacy Technician Fee ONLINE. You must include a copy of your receipt as part of the Program Application. 11. Students must go to Eligibility Policy (PTCB) and review the information pertaining to pharmacy technician certification eligibility requirements. Important! Your application must contain all of the required documents and be legible to be considered for admission to the program. Applicants should keep their original documents and submit only copies with their application. Please use the attached checklist to ensure that you are submitting everything that is required. Please submit your application via the U. S. Postal Service as described within this packet. Thank you. 10 P a g e
Advising Students seeking admission to the Pharmacy Technician Certificate Program must see an academic advisor to confirm completion of all of the pre-entry courses, and to review all transcripts after they have been evaluated. Transcripts must be official transcripts sent directly from your previous institution(s) to the Yavapai College Registrar. Once the transcripts are received, it is your responsibility to contact Advising and request to have them evaluated. You may contact Advising at 928-776-2106 for the Prescott campus or at 928-634-6510 for the Verde campus. Admissions Enrollment is limited and the selective admission process is highly competitive. Students must meet the minimum admission requirements of the program and those required for admission to Yavapai College. Admission to the program is based on a point value system. Please refer to the Program Selection Criteria on page 13. If an applicant is still in the process of completing pre-entry course work, they may still apply to the program. However, all pre-entry course work must be completed prior to Summer admission. Readmission to the Program The Pharmacy Technician Certificate is a one year program. The program accepts applicants once per year in the Summer Semester. Students are admitted through an application process and move through the program as a cohort. Students that are unable to complete the semester or fail to successfully complete a course will be dropped from the program. Students may apply for readmission to the program. Readmission is based on availability and is not guaranteed. If readmission is feasible, students will be required to take a competency assessment to determine appropriate placement within the program. As a result, students may be placed in a semester prior to the one that they dropped out of. 11 P a g e
Estimated Cost for the Pharmacy Technician Certificate 2015-16 (Based upon Arizona Resident Student Status) Tuition-pre-entry + program courses $96.00/credit X 23 credits $2,208.00 Liability Insurance Varies Textbooks -if estimated at $100.00 per course, $600.00 with 6 courses within the pharmacy technician program Pharmacy Technician trainee license fee $46.00 PTCB exam (students will take at the end of the third $129.00 semester) Background check $69.00 Drug Screen $59.00 Uniforms and shoes Varies by vendor $150.00 Immunizations Varies by provider $350.00 Lab fees Vary by course and semester Varies Fingerprint Clearance card $65.00 The above information is provided to give students, parents and advisors an approximate cost of the program. These are only estimates. The actual costs may be higher or lower. Financial Aid Financial aid may be available to you. Please contact the financial aid office at 928-776-2152 for the Prescott campus or 928-634-6502 for the Verde campus. 12 P a g e
Pharmacy Technician Certificate Program Selection Criteria Admission to the program is based on a point system, utilizing the criteria listed below. Students will be required to provide proof of residency (residency, for tuition purposes, is defined by the Arizona State Legislature and is outlined in the Yavapai College catalog), military status, grade point average, and registration at Yavapai College. Proof of coursework and registration history will be established by the records on file in the Registrar s office. Selective Admissions Point System (This system is based on a total of 46 possible points.) Residency Residency within Yavapai County 10 pts Residency within the state of Arizona 5 pts Residency outside state or country 0 pts Cumulative Grade Point Average Military 3.50-4.00 15 pts 2.50 3.49 10 pts 2.00 2.49 5 pts Veteran 2 pts 500 Word Essay 12 pts Describe what you know about the pharmacy technician profession at this point in time. Describe why you want to become a pharmacy technician. Discuss how you plan to use your pharmacy technician certification. The program is taught almost entirely online. Tell us why you think that you are prepared to be successful as an online student. Content 8 pt Typed 1 pt Spelling 1 pt Double spaced 1 pt 500 words 1 pt Work Experience in Healthcare Field (subject to verification) Two Letters of Recommendation (Current or previous employer or educator) 4 pt 3 pts 13 P a g e
Zero Tolerance Guidelines The Yavapai College Pharmacy Technician Certificate Program supports a Zero Tolerance Policy. Any Pharmacy Technician student engaging in the following behaviors is subject to immediate dismissal from classes and disciplinary action as described in the Yavapai College Student Handbook, the Yavapai College Allied Health Student Handbook and the Yavapai College Code of Student Conduct. 1. Intentionally or recklessly causing physical harm to any person on the campus or at a clinical site, or intentionally or recklessly causing reasonable apprehension of such harm. 2. Unauthorized use or possession of any weapon or explosive device on the campus or at a clinical site. 3. Unauthorized use, distribution, or possession of any controlled substances or illegal drug for any purpose (i.e., distribution, personal use) on the campus or at a clinical site. 4. Any misconduct covered by the Yavapai College Code of Student Conduct. Medical Marijuana Act (Proposition 203) In 2010, Arizona voters approved the Arizona Medical Marijuana Act (Proposition 203), a state law permitting individuals to possess and use limited quantities of marijuana for medical purposes. Because of its obligations under federal law, however, Yavapai Community College will continue to prohibit marijuana possession and use on campus for any purpose. Under the Drug Free Workplace Act of 1988, and the Drug Free Schools and Communities Act of 1989, no institution of higher education shall be eligible to receive funds or any other form of financial assistance under any federal program, including participation in any federally funded or guaranteed student loan program, unless it has adopted and has implemented a program to prevent the use of illicit drugs and abuse of alcohol by students and employees. Another Federal law, the Controlled Substances Act, prohibits the possession, use, production and distribution of marijuana for any and all uses, including medicinal use. This law is not affected by the passage of the Arizona Medical Marijuana Act. Because Yavapai Community College could lose its eligibility for Federal funds if it fails to prohibit marijuana, it is exempt from the requirements of the Arizona Medical Marijuana Act. Therefore, Yavapai Community College will continue to enforce its current policies prohibiting the unlawful manufacture, distribution, dispensation, possession or use of a controlled substance on its property or as part of any of its activities. 14 P a g e
Students who violate Yavapai Community College policy prohibiting the use or possession of illegal drugs on campus will continue to be subject to disciplinary action, up to and including expulsion from school and termination of employment. (HR policy 2.6.2) Immunizations Students should submit copies of their immunization records, and retain the originals for their own files. The Department of Allied Health is unable to provide copies of these records to replace lost originals. Students are responsible for remaining in compliance with all mandated immunizations, immunization records, and students must adhere to all deadline requirements. Copies of updates to immunization records must be submitted to the Allied Health Administrative Assistant for the student files as mandated by the Division in order to continue in the program. All immunization records must include your name and the name and signature of the healthcare provider giving the immunization and the date. Required Immunizations 1. MMR (measles/rubeola, mumps, rubella) Options to meet this requirement: a. Attach a copy of proof of two previous MMR vaccinations to the health declaration form. OR b. If you have had all three illnesses OR you have received the vaccinations but have no documented proof, you must have a titer drawn for each illness. i. If the titer results are POSITIVE, attach a copy of the results to the health declaration form. OR ii. If the titer results are NEGATIVE, you must get two MMR vaccinations (each 30 days apart) and attach documentation to the health declaration form. 2. Varicella (chicken pox) Options to meet this requirement: a. Attach a copy of proof of a POSITIVE IgG titer for Varicella. OR b. If the titer is NEGATIVE, attach a copy of proof to the health declaration form that you received two Varicella vaccinations (each 30 days apart) and attach documentation to the health declaration form. 15 P a g e
3. Tetanus/Diphtheria and Pertussis (Tdap) immunization within the past 10 years. Attach a copy of proof of Tdap vaccination to the health declaration form. 4. Tuberculosis Options to meet this requirement: a. Attach a copy of proof of a recent TB skin test (PPD), TB skin test must be current. Records for PPD (skin testing for tuberculosis) require name and signature of the healthcare provider and findings. OR b. If you have a POSITIVE TB skin test you must submit a chest x-ray diagnostic report stating negative for TB and must be current. 5. Hepatitis B In order to apply to the Program, you must complete at least one injection and stay on track with the subsequent two injections according to the timeline set forth in c, below. Options to complete this requirement: a. Attach a copy of proof of completion of three Hepatitis B injections to the health declaration form. OR b. Attach a copy of proof of a POSITIVE HbsAB titer to the health declaration form. OR c. If you have not received the injections in the past, you must obtain the first injection and attach a copy of proof of the injection to the health declaration form. Then, you must receive the 2 nd injection in one month and the 3 rd injection five months after the second injection. d. Submit documentation to Allied Health Administrative Assistant. Background Check All students are required to obtain a background check. Information regarding how to obtain the background check will be provided to the student upon provisional acceptance to the program. The cost of this background check is at the student s expense. Due to clinical agency contracts, any negative results will be reviewed to determine admission or continuation in the program, on a case-bycase basis by the Allied Health Director and the Pharmacy Technician faculty. 16 P a g e
Arizona DPS Fingerprint Clearance Card Fingerprinting is available through the Yavapai College Campus Safety/Police office on the Verde Valley and the Prescott campuses. The Campus Safety/ Police office will provide you with a card of your fingerprints and the Arizona DPS Fingerprint Clearance Card application. Students must mail their fingerprints, the application and the required fee to the Arizona Department of Public Safety for processing. Processing may take 6-13 weeks. Copies of both sides of the card are required as part of your documentation. Fingerprint clearance card applications are available at the Yavapai College Campus Safety Department. Fingerprinting can be done during the hours of 9:00 a.m. 12 noon Wednesdays, at no charge. Campus Safety, on the Prescott campus, is located in the Welcome Center in Building 28, Room 102, telephone number (928)776-2185. Verde Valley Campus, Safety Department is located in Building F, telephone number (928) 634-6574. http://www.azdps.gov/reports/fingerprint/faq/default.asp CPR for Health Care Providers You must have current CPR for Health Care Providers certification that will not expire prior to the end of your internship or program. CPR for Health Care Providers must be pre-printed on the card. Yavapai College offers this half credit course, EMS123, in a one day session year round. If you are using another provider, it is your responsibility to ensure that it meets the program/ internship requirements. Yavapai College Allied Health Department does not accept online CPR certifications. Drug Testing Random drug testing is a standard procedure throughout the Pharmacy Technician Certificate Program. The first drug test will be at the student s expense. Any subsequent drug testing will be done at the program s expense. When a student is informed that they are a subject of random drug testing, they will be provided an appropriate form and a list of local laboratories that they can utilize and the drug testing must be completed by the end of that business day. 17 P a g e
Pharmacy Technician Trainee Permit Students are required to have a Pharmacy Technician Trainee Permit issued by the Arizona State Board of Pharmacy prior to beginning the internship in the third semester of the program. Students will not be allowed to participate in the internship without this permit. Please go to this link to review the requirements for obtaining this permit: http://www.azpharmacy.gov/ 18 P a g e
Yavapai College Pharmacy Technician Certificate APPLICATION FOR ADMISSION Personal Please Print or Type Y# Name: (Last) (First) (Middle) Address: (Street) (City, State) (Zip Code) Telephone Numbers: (Home) (Work) (Cell) E-mail address: Are you a veteran? Yes No Education Name and Location of School GED or High School From: Mo/Yr Dates Attended To: Mo/Yr Degree Awarded College Other 19 P a g e
Employment History Name & Address of Employer Position From: Mo./Yr. To: Mo./Yr. Reason for Leaving 1. 2. 3. 4. PLEASE READ CAREFULLY AND SIGN BELOW I certify that the information on this application is complete and accurate to the best of my knowledge. I understand that withholding information or giving false information may make me ineligible for admission and enrollment. I release from all liability or damages those persons, agencies, or organizations who may furnish information in connection with my application for admission. If accepted, I agree to read and abide by all school and Department policies and procedures. Signature: Date: 20 P a g e
Waiver of Licensure/Certification Guarantee Admission to, or graduation from, the Yavapai College Pharmacy Technician Certificate Program does not guarantee certification with the Pharmacy Technician Certification Board (PTCB) or licensure with the Arizona State Board of Pharmacy. Licensure, certification and registration requirements and the subsequent procedures are the exclusive right and responsibility of those agencies. Applicants should review the Arizona State Board of Pharmacy and Pharmacy Technician Certification Board websites prior to applying to the program to determine if they are eligible to sit for the Pharmacy Technician Certification Board Exam and obtain licensure with the State Board of Pharmacy. Arizona State Board of Pharmacy: http://www.azpharmacy.gov/ Pharmacy Technician Certification Board: https://www.ptcb.org//am/template.cfm?section=home1 I have read and understand the information regarding certification and licensure discussed on these websites. Applicant s name Applicant s signature Date 21 P a g e
Immunization and Documentation Cover Sheet Please complete this form and attach all supporting documentation. Name: YC Student ID Number: IMMUNIZATIONS: Date of 1st MMR Immunization Date of 2nd MMR Immunization OR Date of Titer: Date of 1st HepB Immunization Date of 2nd HepB Immunization (2nd HepB not required for program entry) Date of 3rd HepB Immunization (3rd HepB not required for program entry) Date of 1st Varicella Immunization Date of 2nd Varicella Immunization OR Date of Titer: OR Date of Titer: Date of Tdap Immunization DOCUMENTS: Arizona DPS Fingerprint Clearance Card Number Expiration Date: Copy of Yavapai College Student ID card (with photo) OR Driver s License. Copy of CPR for Healthcare Providers card (front & back) must be valid. Copy of Negative TB Skin Test OR a Chest X-Ray Diagnostic Report (the test or report must be current). Waiver of Licensure/Certification Guarantee form. Pre-Entry Check Sheet Form for the Pharmacy Technician program signed by the Academic Advisor with copies of all official transcripts attached. Remember: Copies of all documents in support of the information provided by you must be attached as part of a complete application. 22 P a g e
Application Checklist for Pharmacy Tech Program Pharmacy Technician Application (mail to: Pharmacy Technician Applications, Yavapai College, 1100 E. Sheldon Street, YC Box 6097, Prescott, AZ 86301. Deadline: April 1, 2016, must be postmarked by midnight.) Official Transcripts from other educational institutions (must be mailed directly to the Yavapai College Registrar s Office, 1100 E. Sheldon St., Prescott, AZ 86301). Two Letters of Recommendation (current or previous employer or educator). Negative TB Skin Test or a Chest X-Ray Diagnostic Report (the test or report must be current). CPR for Healthcare Providers (must be current). Five Hundred Word Essay (address content on the selection criteria form). Pre-Entry Check Sheet Form for the Pharmacy Technician program signed by an Academic Advisor with copies of all transcripts attached. Copy of both sides of Arizona Department of Public Safety Issued Level-One Fingerprint Clearance Card. Copies of all immunizations or titers in support of your Immunization and Documentation cover sheet. Receipt for payment of $50.00 non-refundable application fee. (Please make payment with either the Yavapai College Cashier to receive this Receipt OR make payment on-line at yc.edu/radiology by clicking on The Marketplace: Pay Pharmacy Technician Fee ONLINE ). Waiver of Licensure Guarantee signature sheet. (Page 21) Guidelines for the Pharmacy Technician Trainee Application: You must be at least 18 years of age to be licensed as stated by Arizona law. Proof of Legal US Residency Proof of High School Graduation or Equivalent of High School For more details please go to: http://www.azpharmacy.gov/pdfs/guidelines%20(tech).pdf 23 P a g e