Fillable Form 1: Pharmacy Technician Application (Portland Community College)

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Form 1: Pharmacy Technician Application (Portland Community College)

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1
For more information, contact the
PCC Institute for Health Professionals.
1626 SE Water Ave Portland OR 97214
971.722.6633 | climbhealth@pcc.edu
Pharmacy Technician Application
Program Description
Pharmacy Technicians work in a fast-paced health
environment under the direction of a pharmacist.
IHP’s Pharmacy Technician Program combines online
learning with onsite lab practicums at the CLIMB
Center. This course prepares students to take the
Pharmacy Technician Certication Board’s PTCB
exam. Visit www.ptcb.org for more info.
Course content includes:
• Medical terminology specic to pharmacy.
• Reading and interpreting prescriptions.
• Dening drugs by generic and brand names.
• Students will learn about dosage calculations
and conversions, dispensing prescriptions, and
inventory control.
NOTE: To work in the State of Oregon, you must apply to be
approved as a Pharmacy Technician. Please be advised that
certain convictions may prevent license issuance. Please
contact the Oregon Board of Pharmacy if you have any
questions in regards to their application and background
check prior to joining the program. The Oregon Board of
Pharmacy can be reached at 503.731.4032 or on their website,
www.pharmacy.state.or.us.
Time
• 2 terms, 160 hours, about 6 months to complete.
Tuition
• $3,140.00, excluding books. Tuition is due at the
time of registration, or students may set
up a 3-month payment plan with the Portland
Community College Student Account Services For
Information about the payment plan, please visit the
PCC payment plan web-page.
Attend a Pharmacy Technician Free
Informational Session to learn more
about the program, job placement
and internship opportunities.
Informational Session:
6pm on Thursday, February 27th, 2020
at the PCC CLIMB Center
Applications Due:
Monday, March 2nd, 2020
Mail or deliver required documents
and this application form to:
Attn: Pharmacy Technician
PCC Institute for Health Professionals
1626 SE Water Ave
Portland, OR 97214
Late or incomplete applications will
not be accepted.
Dates to Remember
Send Application Materials
spring, 2020
2
For more information, contact the
PCC Institute for Health Professionals.
1626 SE Water Ave Portland OR 97214
971.722.6633 | climbhealth@pcc.edu
Pharmacy Technician Application Packet Checklist
Check O Documents
We require the following documentation to be
submitted for consideration into the program.
Do not submit original documents.
•
Math 95 or above. Transcript or math placement
test result is accepted
Writing 115 or above. Transcript or writing
placement test result is accepted.
COPY of High school completion or GED
certificate. A College or University degree can
substitute.
Answer and submit the following:
What does a Pharmacy Technician do
and why do you want to be a Pharmacy
Technician?
• Imagine you have a patient who is very upset
when you inform them that their insurance
doesn’t cover their medication. How would
you handle the situation?
Students must pass a background
check and drug screen in order to
participate in the clinical portion of
this course or apply for the board
exam. Please contact the Oregon
Board of Pharmacy if you have any
questions regarding the background
check requirement prior to applying.
• Make sure you have included
all requested materials before
submitting your application.
Incomplete or late applications will
not be accepted.
• Submitting a registration form does
not signify or guarantee that you will
be registered or accepted into the
Pharmacy Technician program.
• You must be age 18 when class
begins.
Background Check
Please Keep in Mind
Note to Admissions:
3
Registration Form Non-Credit/CEU Classes
1
CRN (5-digit number)
CRN (5-digit number)
CRN (5-digit number)
CRN (5-digit number)
Course Title
Course Title
Course Title
Course Title
Part A: Course Registration Requests
Phone: 971-722-8888, option 2 Online: pcc.edu/nc Fax: 971-722-4988 Mail: PO Box 19000, Portland OR 97280
Are you a veteran of the U.S. Military?
Yes
No
2 3
4
5 6
7
8
9 10
PCC ID Number (“G Number”)
Last Name Other Names Used
First Name Middle Initial Gender
Mailing Address
Email Address
Daytime Phone Number
High School/GED – Name of School/Institution
Evening Phone Number
City
City
State
State
ZIP
Year Graduated/Obtained
Student Status
New PCC Student
Currently Enrolled at PCC
Previously Attended PCC
Male
Female
Date of Birth (MM/DD/YYYY)
Select one or more of the following racial categories to describe yourselfDo you consider yourself to be Hispanic/Latino?
Are you an Oregon resident?
Citizen Type
PCC is committed to affirmative action goals and would appreciate your response to the following:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
U.S. Citizen
Resident Alien/Refugee/Immigrant
Other, Enter Type
Yes
No
Yes
No
Part B: Student Information
11
Signature
Part C: Registration Confirmation
My enrollment with Portland Community College will signify my consent to and acceptance of all policies and procedures governing my enrollment, including financial liability.
If I fail to remit payment when due, I will promise to pay to PCC all reasonable costs for collection, including collection agency fees.
Date (MM/DD/YYYY)
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Form 1: Pharmacy Technician Application (Portland Community College)

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Completed 25 August 2020

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