Pharmacy Technician Program Application Header Image

Pharmacy Technician Program Application

Name*
Address*
Date of Birth*
Gender*
Race/Ethnicity*
Do you have a high school diploma?*
Are you currently pursuing a high school diploma?*
Do you have a GED?*
Are you currently pursuing a GED?*

A COMPLETE APPLICATION FOR ADMISSION INTO THE PHARMACY TECHNICIAN PROGRAM MUST INCLUDE: 

-Government Issued ID 

Class registration is on a first come first serve basis. Classes fill up quickly.

I hereby attest that the information given is accurate and complete to the best of my knowledge. I understand that submission of false or misrepresented information subjects me to refusal of enrollment or dismissal from the program. I acknowledge that the completion of Pharmacy Technician courses will not earn any college credits.

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Enterprise State affords equal opportunity to all employees and applicants for admission or employment regardless of race, color, gender, religion, national origin, age or disability. Enterprise State will make reasonable accommodations for persons with disabilities. Questions concerning Title IX or the Americans with Disabilities Act should be directed to Kevin Ammons at 334-347-2623 x2297.

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