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UW Health SMPH
American Family Children's Hospital
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Applying to the Pharmacy Technician Training Program

To apply to the UW Health Pharmacy Technician Training Program, complete the form below and select the Submit button.

 

If you would prefer to submit a hard copy application, you may print and complete the Pharmacy Technician Training Program Application for Admission (pdf). There is no cost to apply to the Pharmacy Technician Training Program.

 

Please note: Incomplete applications will not be considered.

 

Dates to remember:

  • We have classes that start in January and September; we are currently accepting applications

Minimum Applicant Requirements

 

In order to apply, you must first meet the following minimum requirements:

  • At least 18 years of age upon first day of class
  • Possess a high school diploma or equivalency certificate

Note: All fields are required. Enter N/A if not applicable.

 

Personal Information

 

Last Name:

Middle Name:

First Name:

Former Name:

Home Phone:

Work Phone:

Mobile Phone:

E-mail Address:

Street Address:

City, State and ZIP:

Date of Birth:

Gender:

 

Education History

 

High School Attended:

 

Did you graduate?

 

Graduation/GED Date:

 

 

College or Technical School/Program:

Program of Study:

Years Attended:

Did you graduate?

 

 

College or Technical School/Program:

Program of Study:

Years Attended:

Did you graduate?

 

 

Employment History

 

Are you currently employed?

 

Employer Name:

Dates Worked

Position:

 

 

Employer Name:

Dates Worked

 

Position:

 
   

Employer Name:

Dates Worked

 

Position:

 

 

 

Volunteer History

 

Organization:

Position:

Dates:

 

 

 

 

Organization:

Position:

Dates:

 

 

 

Background

 

Have you ever been convicted of a felony?

 

If yes, explain:

 

 

Pharmacy Experience

 

Have you ever worked as a pharmacy technician?

 

Have you ever taken any formal pharmacy technician training courses/classes?

 

 

If yes, explain:

 

 

 

Briefly state why you are interested in a career as a pharmacy technician:

 

 

How did you hear about the Pharmacy Technician Training Program? 

 

Online
 or Other (please describe below)