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Pharmacy Technology (PHM) Program (Durham Technical Community College)

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The Pharmacy Technology (PHM) Program (Durham Technical Community College) form is 7 pages long and contains:

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  • 22 check-boxes
  • 21 other fields

Country of origin: US
File type: PDF

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For Admissions use only.
Received By: ___________
Return this form to:
Admissions Registration, and Records.
View submission instructions below.
Date: _
Pharmacy Technology (PHM) Program
☐ Associate Degree ☐ Diploma ☐ Hospital Pharmacy Certificate
First Name__________________________________ Last Name_________________________________
Durham Tech Student ID Number _____________________________ Date _________________________
ConnectMail Email Address: _______________________________________________________________
NOTE: All official communication from the college is delivered via ConnectMail, including Health Technology admissions
decisions.
PHM program applications are accepted throughout the year.
Enrollment deadlines refer to applying to the College.
Email Donna Alston if you have questions.
Submit completed application packets electronically to Admissions, Registration, and Records. Follow the instructions
to submit electronic documents using our secure system. Acceptable digital formats include PDF, JPEG, TIFF, GIF, and
PNG. No faxed or emailed applications will be accepted.
CHECKLIST:
All steps below are required. Please check that each item is completed.
☐ Attend a PHM Information Session (view the list on the program web page)
Enroll at Durham Technical Community College
View College enrollment steps on the website.
☐ I am currently admitted to Durham Tech.
Note: If you have not been enrolled with Durham Tech within the last 12 months, you must reapply to
Durham Tech using the CFNC application.
☐ I have submitted an official transcript(s) from high school or college.
Submit to Admissions, Registration, and Records, located in the Wynn Center (Building 10), room 10-201
Note: If official transcripts were submitted upon enrollment at the College, there is no need to resubmit them for
admittance into the PHM program, unless additional courses have been completed.
☐ I have applied for Financial Aid (recommended but not required).
☐ I have attended a ConnectSession (Student orientation)
Note: Prospective students with 12 or more college credit hours transferred to Durham Tech are not
required to attend a ConnectSession, but it is recommended.
Meet Course Placement Requirements
Students must demonstrate they are college ready in one of the following ways (check one):
☐ Provide proof of unweighted US high school GPA of 2.8 or higher within the last ten years
☐ Transfer credit for English and math (college-level algebra)
☐ Provide proof of completion of an associate’s or bachelor’s degree
☐ Provide proof of satisfactory scores on ACT, SAT, GED, HiSET, NCDAP, COMPASS, ASSET, or ACCUPLACER scores
1
within the last ten years
☐ Demonstrate mastery on RISE English placement test 2 and RISE Math placement test 2; OR successfully
complete ENG-002 through Tier 2 (grade of P2) and MAT-003 through Tier 2 (grade of P2)
Additional Required Documents:
Students must provide all of the documents listed below with the completed application:
☐ I have signed the Clinical Training Form (attached below)
☐ I have signed the English Language Requirement Form (attached below)
☐ I have signed the Essential Skills Form (attached below)
Statement of Student Responsibility
I verify that I have read all the information regarding admissions to the Pharmacy Technology program, and
understand the steps I must take to qualify for admissions. I understand that it is my responsibility to notify
Admissions, Registration, and Records regarding changes in name, address, or phone number.
I understand that all official communication from the college is delivered via ConnectMail, including Health and
Wellness admissions decisions.
I understand that my Pharmacy Technology application will not be accepted unless everything is completed.
Signature __________________________________________ Date ___________________________
2
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PHARMACY TECHNOLOGY PROGRAM
ESSENTIAL SKILLS FOR ADMISSION AND PROGRESSION
PHYSICAL AND PSYCHOLOGICAL REQUIREMENTS
Students applying to the Pharmacy Technology program must demonstrate sufficient physical and emotional health to
be considered fit to participate in academic education and laboratory experiences, and to practice clinically with the
public in a safe and effective manner.
ISSUE
STANDARD
EXAMPLES OF NECESSARY ACTIVITIES (not inclusive)
CRITICAL THINKING
Critical thinking ability
sufficient for problem solving
and clinical judgment.
• Identify cause and effect relationships in clinical situations
• Understand and participate in appropriate interventions to
reduce medication errors
• Consider and handle multiple priorities efficiently
INTERPERSONAL
SKILLS
Interpersonal abilities
sufficient to interact
appropriately with individuals
from a variety of backgrounds.
• Establish rapport with health care workers and patients
• Cope effectively with stress in the workplace
• Demonstrate a high degree of patience
COMMUNICATION
Communication abilities
sufficient for professional oral
and written interactions.
• Give formal/informal reports
• Interact with patients and health care workers
MOBILITY
Physical abilities sufficient to
move throughout facilities and
within small spaces to provide
effective medication
distribution.
• Move around efficiently in pharmacy, sterile preparation
work areas, corridors, and patient care areas
• Stand for excessive periods of time
• Squat, reach above head, lift, push, pull
• Walk the equivalent of 5 miles daily at work
MOTOR SKILLS
Gross and fine motor abilities
sufficient to provide safe and
effective pharmacy services.
• Perform manipulations required for sterile and non-sterile
compounding, packaging, etc.
• Calibrate, maintain and use equipment involved in medication
delivery
• Utilize gross, fine motor skills and repetitive movements
HEARING
Auditory ability sufficient to
maintain work environment
• Hear equipment alarms, emergency signals, etc.,
• Hear telephone communications
VISION
Visual ability sufficient for
observation and accuracy in
pharmacy practice.
• Inspect medications for signs of degradation
• Read equipment calibrations and instrument graduations
•
Read fine print
TACTILE
Tactile ability sufficient for
pharmacy practice activities.
• Perform manipulations involving manual dexterity or passive
range of motion
EMOTIONAL
Emotional stability sufficient to
maintain composure in
stressful situations.
• Interact appropriately with peers, patients and supervisors at
all times, including high stress, fast paced and/or undesirable
situations
• Receive corrective feedback calmly
ENVIRONMENTAL
Ability to tolerate
environmental stressors.
• Adapt to variations in work schedule
• Work with pharmaceuticals and chemicals required for
pharmacy practice
• Work in situations that require wearing protective garments
• Work in areas that are close or crowded
A prospective student with a disability that may impact their ability to perform one or more of these skills, provide
patient care, or participate in other job activities, is encouraged to contact an Accessibility Services counselor for
assistance.
3
I certify that I have read the Essential Skills for Admission and Progression form. I certify that I understand the physical
and psychological requirements for pharmacy technology professionals. I have assessed my ability to perform these
skills and am able to demonstrate these essential skills.
Name (print) ______________________________________ Student ID# ________________________
Signature ________________________________________ Date ______________________________
4
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Statement of Policy Regarding Acceptance for Clinical Training in the Following
Programs at Durham Technical Community College
Associate Degree Nursing Medical Assisting Practical Nursing
Anesthesia Technology Occupational Therapy Assistant Respiratory Therapy
Clinical Trials Research Associate Pharmacy Technology
Surgical Technology
Health Information Technology Medical Product Safety and Pharmacovigilence
Students accepted into the above programs must meet the standards of both the College and the
affiliated clinical sites in order to participate in the appropriate clinical training for the program. Each
clinical site where a student receives training reserves the right to refuse clinical training to any student
found to be unacceptable according to that site’s policies and regulations. Clinical sites require a
Criminal Background Check (CBC) prior to the student’s placement for training at that site.
Reasons for refusal could include, among other considerations, a documented criminal background check
indicating convictions for drug or alcohol related charges, child abuse or molestation, burglary, larceny, or
other convictions deemed inappropriate to the particular clinical setting. In addition, students may be
required to submit to a 12-panel drug screening per the clinical site’s requirement.
The student must conform to and be subject to all policies and regulations of the assigned clinical site. The
site reserves the right to end clinical training of any student whose performance violates rules, policies,
procedures or professional standards expected by the agency. Written justification from the clinical site will
be provided to the college for such suspension. The clinical site and college personnel reserve the right to
take appropriate immediate action, when necessary, to maintain the proper and safe operation of its
facilities and the safety of clients in the clinical setting.
Criminal Background Check and Drug Screening: When students are admitted into the program of study, the
student receives the CBC and drug screening information and directions: The criminal background check will
include reports from all states where the student has lived, worked, or gone to school from the date that they
turned eighteen (18) years of age. The CBC will include both felonies and misdemeanors. The National Sex
Offender Registry is included in the CBC. Flagged reports are sent directly from the designated CBC vendor to
the clinical sites. Durham Tech does not retain copies of the results. Note: Please do not get this report from
your local police department. The drug screening is a 12-panel test.
Students will pay a fee directly to a designated vendor for the CBC and drug screening.
Additional information on the Criminal Background Check requirement may be obtained from the Durham
Tech website.
I verify that I have read and fully understand the Statement of Policy Regarding Acceptance for Clinical
Training at Durham Technical Community College. I also understand that a criminal background check
and/or drug testing will be required for placement in clinical training sites for Durham Technical Community
College.
NAME (Print) __________________________________________ STUDENT ID# ______________________
Program of Study _________________________________________________________________________
SIGNATURE ___________________________________________ DATE ____________________________
Health Technologies Clinical Training Form 6/2018
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Durham Technical Community College
English Language Requirement Form
All health care workers (native and non-native U.S. English speakers alike) are expected to use clear
communication skills in the workplace. Students whose native language is not U.S. English are expected
to demonstrate "near native" U.S. English language abilities. To confirm this ability, all students entering
a Health Technologies program are required to meet the English language requirement.
Students meeting the following criteria must comply with this revised requirement:
1. Students who applied to a Health and Wellness program on or after January 1, 2016, OR
2. Students who applied to a Health and Wellness program before January 1, 2016, but have not
yet met the previous English language requirement.
Please check the ONE that applies:
☐ I have only attended a U.S. high school, and my first language is U.S. English.
☐ I have attended school outside the United States.
☐ My first language is not U.S. English.
If you checked the first checkbox, please sign here. There is nothing further that you need to do.
I understand that this is an official Durham Technical Community College document and that any
falsification on this document may result in disciplinary action according to the Student Code of
Conduct.
My signature below indicates that I am responding truthfully.
Student Name (print): ____________________________________ Student ID: __________________
Student Signature: _______________________________________ Date: ______________________
If you checked the second or third checkboxes, you must meet the English Language Requirement by
successfully completing one of the following options listed on the following page.
1. Take the Duolingo English Test and score 100 points or higher or
2. Take the Test of English as a Foreign Language (TOEFL), iBT version (obtain a score of 22 in
listening and above 26 in speaking or
3. Complete EFL 055 OR EFL 064 and other EFL courses as recommended or required by placement
testing (obtain a score of 80% or above).
Note: Scores for the above tests and classes are valid for up to 5 years.
I understand that this is an official Durham Technical Community College document and that any
falsification on this document may result in disciplinary action according to the Student Code of
Conduct.
English Language Requirement Form, revised Nov. 2020 1
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I checked the second or third checkboxes; however, I have met the English Language Proficiency
Requirement as follows:
☐ I have taken the Duolingo English Test and scored 100 points or higher.
☐ I took the Test of English as a Foreign Language (TOEFL), iBT version and scored above 22 in
listening and above 26 in speaking.
☐ I have completed one or more EFL curriculum courses in the areas listening/speaking and have
scored an 80% or higher.
My signature below indicates that I am responding truthfully.
How to complete this section: Fill in your name but no other information in the admissions application
and email it to wilderp@durhamtech.edu. She will sign it and return it to you. You can then complete
the application and submit it electronically (see instructions at the top of the application).
Student Name (Print): ___________________________________ Student ID: __________________
Student Signature: ______________________________________ Date: ______________________
EAP Representative Name/Title ________________________________________________________
EAP Representative Signature: ___________________________________ Date__________________
English Language Requirement Form, revised Nov. 2020 2
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Pharmacy Technology (PHM) Program (Durham Technical Community College)

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Completed 3 February 2021

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