Pharmacy Technician Trainee Program Application

Pharmacy Technician Trainee Program Application

First Name*

Last Name*

Date of Birth*

Phone*

Phone

E-mail*

Address*

City*

State*

Zipcode*

Last 4 digits of your Social Security Number*

This is needed to create and/or verify your university ID number

High School Diploma/GED

Students may need proof of high school/GED or equivalent diploma in order to take the exam but this will be collected by the test givers, U of U will not be checking proof documents.

Any questions regarding diploma requirements should be directed to testing organization.

Applicants must be at least 17 years of age.

Students must be 18 years of age and will be asked by PTCB to submit proof of a high school diploma/GED or equivalent to take the Pharmacy Technician Certification Board (PTCB) Exam.

College Education, Degrees, or Certificates Obtained*

Please list any colleges attended (if any) and dates. Also provide any other degrees or certificates. This experience is not required, but it tells us more about yourself.

Have you ever attended or been an employee of the University of Utah?*

Please check this box if you are a current employee of University of Utah Health

Personal Statement*

Please tell us about yourself.

Why are you interested in becoming a Pharmacy Technician?*

Why did you choose the University of Utah Pharmacy Technician Program?*

Preferred Method of Contact

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