Certified Pharmacy Technician
Program Requirements Checklist & Forms
In order to participate in the Certified Pharmacy Technician course, participants must complete all of the
following requirements before the last day of class. All documents must be submitted on or before the
last day of class.
Please allow at least three weeks prior to the last class day to complete the enrollment requirements. Please use
guide below to ensure all requirements are satisfied in a timely manner.
Three weeks prior to last day of class:
• Complete Pennsylvania State Police Background Check.
• Complete FBI background check, ONLY if you have not resided in PA for past two consecutive years.
Two weeks prior to the last day of class:
• Complete drug screening test. Information about the drug screen will be sent to participants after enrollment.
Requirements Checklist
Must be at least 18 years of age to attend class.
Enroll in the course. Register online at northampton.edu/lifelearn or by calling 1-877-543-0998. Please reference
course code PHARM102 when registering. Course fee is due at the time of registration via credit card.
Completed Student Information Form.
High School Diploma or GED
All participants must complete the following requirements prior to the last day of class in order to participate
in the externship.
Completed Pennsylvania Criminal Background Check (dated less than one year through class completion date).
FBI Clearance must be completed only if you have not resided in PA for the past two consecutive years.
Please note: background checks may not contain prohibitive offenses as cited in Act 14. The Act 14
documentation is included in this electronic packet.
Completed drug screen.
Withdrawal & Refund Policy
To withdraw, please go to northampton.edu/LifeLearn, log in and complate a drop request. Withdrawals must be
completed five business days prior to the course start date to obtain a full refund. For more information, please visit
northampton.edu/NoncreditRefund.
Questions
Please call 610-332-6585 or e-mail healthcare@northampton.edu with any questions.
Northampton Community College
Fowler Family Southside Center
511 East Third Street
Bethlehem, PA 18015
www.northampton.edu/cbi
FOR OFFICIAL USE ONLY
Verification of Residency
PA Background Check
PHARMACY TECHNICIAN W/EXTERNSHIP TRAINING
PROGRAM
Out of State FBI Check
Social Security Card
Student Information Sheet
Verification of PA Res.
PLEASE PRINT
Other:
Name
Photo ID (Student ID)
Address
Initials:
City/State/Zip
Date:
County
Phone (H)
(C)
*HAVE YOU RESIDED CONTINUOUSLY IN THE STATE OF PENNSYLVANIA FOR THE PAST TWO YEARS?*
Birthdate
Yes
MALE
E-mail Address
No
FEMALE
Please check here if we may email you updates about our classes and programs.
WHO PAID FOR YOUR PHARMACY TECHNICIAN WITH EXTERNSHIP TRAINING?
Self
CareerLink *
Other
*Please provide Name, Address, Phone, and Email Information of your Case Manager/Point of Contact:
SCHOOL BACKGROUND
1. Are you a high school graduate?
Yes
No
3. Have you previously attended college?
Yes
No
2. If not a high school graduate, do you have a G.E.D.?
Degree(s) earned
Yes
No
4. Do you plan to continue your education after this class?
Yes
No
Are you currently employed?
Yes
No
WORK EXPERIENCE
Name and location of employer:
What is your job title?
MINORITY INFORMATION
The following information is requested to monitor the compliance posture of the institution and will be used only to collect and
maintain data on the race, sex, and ethnic identity of all students. This information may be requested on national and state
statistical reports. Please check all that apply to you. (OPTIONAL)
American Indian
Asian
Black/African American
Caucasian
Hispanic/Latino
Native Hawaiian or Other Pacific Islander
Other
HOW TO OBTAIN A PA CRIMINAL BACKGROUND CHECK THROUGH PATCH
The Pennsylvania State Police established a web-based computer application called “Pennsylvania Access
to Criminal History” or PATCH. Using this system, a requestor can apply for a criminal background check
on an individual basis.
The information provided by the requestor will be checked against the criminal history database
maintained by the Pennsylvania State Police Central Repository. If the subject’s information does not hit
on any information in the database, the requestor will receive the results instantly over the Internet and
the requestor can print out the “No Record” certificate. Eighty percent of the time, “No Record”
certificates are returned immediately through the Internet to the requestor. If the subject’s information
hits on something in the database, the requestor receives an immediate “Request under Review”
response.
A “Request under Review” response does not necessarily mean that the individual has a record; it does
indicate the information is being manually reviewed. After review, the status will be updated to “No
Record” or “Record”. The requestor should check the PATCH website periodically for an updated status of
their request.
For all “No Record” responses, the certificate must be printed out at the requestor’s computer.
All “Record” responses will be mailed to the requestor at the address provided by the
requestor. It may take up to two weeks for the status to be updated from a “Request under
Review” to a “No Record” or “Record”.
TO SUBMIT A NEW RECORD CHECK:
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
Log onto https://epatch.state.pa.us and select “Submit a New Record Check” under credit card
users. The fee for the report is $10.00.
When submitting a new record you must enter personal data including your address, social
security, birth date, phone number, etc. You will be asked to verify the data entered on every
screen to continue the process.
Do not use spaces when entering your credit card number.
Please note that the PATCH system will not let you proceed unless you enter the requested
information correctly and completely.
The screen will ask you to wait until the process is complete then click on the control number to
view record. (An example of a control number is #R0712222.) Write down your personal control
number in the event you need to go back to the site to check on anything.
The next screen will display the details of a particular record request. To view/print the
certification form for this request, click the CERTIFICATION FORM link. You should see and print
a report which has a state seal in the background.
IMPORTANT: WE WILL ONLY ACCEPT THE REPORT WITH THE STATE SEAL IN THE
BACKGROUND.
CUSTOMER SERVICE:
Customer service is no longer being handled by the Pennsylvania State Police Help Desk.
Effective immediately, for any questions concerning your criminal background check, the new telephone
numbers are: toll free at 1-888-QUERYPA (1-888-783-7972) or (717)425-5546.
7/09
Pharmacy Technician with externship Resident Abuse Prevention Training Act 14 of 1997 (P.L. 169)
Prohibitive Offenses Contained in 63 P.S. § 675
In no case shall an applicant for enrollment in the Pharmacy Technician with externship training program be approved for
admission into such program if the applicant’s criminal history record information indicates the applicant has been convicted
of any of the following offenses:
(1) An offense designated as a felony under the act of April 14, 1972 (P.L. 233, No. 64), known as “The Controlled Substance,
Drug, Device and Cosmetic Act.” (See 35 P.S. § 780-101 et seq.) 1
(2) An offense under one or more of the following provisions of Title 18 of the Pennsylvania Consolidated Statutes:
Prohibitive Offense Description
Type/Grading of Conviction
CC2501
CC2502
CC2503
CC2504
CC2505
CC2506
CC2507
CC2702
CC2901
CC2902
CC3121
CC3122.1
CC3123
CC3124.1
CC3125
CC3126
CC3127
CC3301
CC3502
CC3701
CC3901
CC3921
CC3922
CC3923
CC3924
CC3925
CC3926
CC3927
CC3928
CC3929
CC3929.1
CC3929.2
CC3929.3
CC3930
CC3931
CC3932
CC3934
CC4101
CC4114
CC4302
CC4303
CC4304
CC4305
CC4952
CC4953
CC5902B
CC5903C or D
CC6301
CC6312
Criminal Homicide
Murder
Voluntary Manslaughter
Involuntary Manslaughter
Causing or Aiding Suicide
Drug Delivery Resulting in Death
Criminal Homicide of Law Enforcement Officer
Aggravated Assault
Kidnapping
Unlawful Restraint
Rape
Statutory Sexual Assault
Involuntary Deviate Sexual Intercourse
Sexual Assault
Aggravated Indecent Assault
Indecent Assault
Indecent Exposure
Arson and Related Offenses
Burglary
Robbery
Theft
Theft by Unlawful Taking
Theft by Deception
Theft by Extortion
Theft by Property Lost
Receiving Stolen Property
Theft of Services
Theft by Failure to Deposit
Unauthorized Use of a Motor Vehicle
Retail Theft
Library Theft
Unlawful Possession of Retail or Library Theft Instruments
Organized Retail Theft
Theft of Trade Secrets
Theft of Unpublished Dramas or Musicals
Theft of Leased Properties
Theft From a Motor Vehicle
Forgery
Securing Execution of Document by Deception
Incest
Concealing Death of a Child
Endangering Welfare of a Child
Dealing in Infant Children
Intimidation of Witnesses or Victims
Retaliation Against Witness or Victim
Promoting Prostitution
Obscene and Other Sexual Materials and Performances
Corruption of Minors
Sexual Abuse of Children
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
Any
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
----------- 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
1 Felony or 2 Misdemeanors
Any
Any
Any
Any
Any
Any
Any
Any
Felony
Any
Any
Any
(3) A Federal or out-of-State offense similar in nature to those crimes listed under paragraphs (1) and (2) above.
For questions pertaining to codes, offenses, or convictions, contact PA Department of Education at (717) 772-0814 or ra-natcep@pa.gov.
1
These offenses could be designated as “CS” on a criminal rap sheet.
294 (Rev 5/2011, 7/8/2014)
Any (1) F or (2) M’s within the 3900 Series (CC3901-CC3934)
Offense Code
FBI CRIMINAL BACKGROUND CHECKS FOR NON-CREDIT STUDENTS
NORTHAMPTON COMMUNITY COLLEGE
Northampton Community College, CBI – Healthcare Education now requires Federal Bureau of Investigation (FBI)
criminal background checks for all students requesting admittance to the Pharmacy Technician with externship
program who have not resided in Pennsylvania for the past two consecutive years. The fingerprint-based
background check is a multiple-step process. Prior to beginning the program, the following will need to be completed
by the student:
1. The applicant must register prior to going to the fingerprint site. Walk in service without prior registration will
not be provided at any fingerprinting location. Registration is available online 24 hours/day, seven days per
week at www.pa.cogentid.com. Applicant must select “Department of Public Welfare (DPW)”, then “Register online”.
2. Telephonic registration is available at 1-888-439-2486 Monday through Friday, 8am to 6pm EST. During the
registration process, all demographic data for the applicant is collected (name, address, SSN, etc.). There is no
data entry required at the fingerprint collection site.
3. The applicant will pay a fee of $36.00 for the fingerprint service and to secure the Criminal History Record.
Applicants may make their payment online at www.pa.cogentid.com using a credit card or debit card. Money
orders or cashiers checks payable to Cogent Systems will be accepted on site for those applicants who do not
have the means to pay electronically. No cash transactions or personal checks are allowed. Fee: $36.00.
Northampton Community College does not reimburse this fee.
Money orders are made payable to Cogent Systems.
No cash, personal or business checks are accepted at print locations.
Payment may be made online at www.pa.cogentid.com.
When registering on-line, for Payment Type, select either Applicant Credit Card or Applicant Money Order.
Required fields will be highlighted in yellow with an asterisk and must be completed. Because of NCC providing
healthcare education for healthcare providers serving all ages, please select “Employment with a significant
likelihood of regular contact with children” for Reason for Fingerprinting. If paying by credit card, be sure to
print out a copy of the on-line receipt of payment to take to the fingerprinting site to verify that payment was
made.
4. The applicant proceeds to the fingerprint site of their choice for fingerprinting. The location of the fingerprint
sites and days and hours of operation for each site will be posted on Cogent Systems’ website at
www.pa.cogentid.com. The location of fingerprint sites may change over time so applicants are encouraged to
confirm the site location nearest to their location.
5. The fingerprint transaction begins when the fingerprinting site reviews the applicant’s qualified State or Federal
photo ID before processing the applicant’s transaction. A list of approved ID types may be found on the Cogent
Systems’ website at www.pa.cogentid.com. Applicants will not be processed if they cannot produce an
acceptable photo ID.
6. After the identity of the applicant has been established, all ten fingers are scanned to complete the process. The
entire fingerprint capture process should take no more than three to five minutes.
7. The applicant’s scanned fingerprints will be electronically transmitted to the FBI as required by federal statute.
8. Pennsylvania Department of Public Welfare (DPW) will receive the FBI Criminal History Record from the FBI.
DPW’s Background Check Unit through ChildLine and Abuse Registry will return the FBI Criminal History Record
to the applicant. The Record will be printed on standard 8.5” X 11” paper that when copied will reveal “Void if
Copied.”
9. The applicant will then provide the original FBI Criminal History Record via mail or hand delivery to the
Program Director’s office by the due date given. Please plan accordingly and allow at least 10 -14 days prior
to the date your paperwork is due for FBI Criminal History Record to be processed. Student will not be eligible
to attend the class if the FBI Criminal History Record has not been returned in the required time frame.
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Medical Assistant
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NREMT-B
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Pharmacy Technician
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RN/LPN Reactivation
INSTRUCTIONS TO NORTHAMPTON COMMUNITY COLLEGE
PHARMACY TECHNICIAN STUDENT
9 PANEL IMMEDIATE URINE DRUG TESTING
FOR PROGRAM REQUIREMENT
As part of your health requirements, you are required to have this test prior to
attending the Pharmacy Technician with Externship program. Please read and
follow the instructions below to expedite this process.
Testing is to be done at:
St. Luke’s North/Occumed Resources
153 Brodhead Road, Bethlehem, PA 18017
Ph: 610-954-3769 / Fax: 610-954-3242
Additional facilitates offering drug screenings can be found at the
following link:
http://www.slhn.org/Conditions-Services/Occupational-Medicine
You may walk in for testing Monday through Friday anytime between the hours
of 7:30 a.m. and 6:00 p.m. If you are unable to make it during those hours,
please call to request an appointment for late night or weekend hours.
PLEASE HAVE DRUG SCREENING COMPLETED AND SUBMITTED PRIOR TO THE
LAST DAY OF CLASS. THIS IS REQUIRED TO BE ABLE TO PARTICIPAT IN THE
EXTERNSHIP.
Instructions:
• Bring photo ID (State Driver’s License or Student ID).
• Report only during the times stated above, or call for appointment.
• Please call Donna Corsi at St. Luke’s North @ 610-954-3769 with
questions.
• Cost for drug screen is $34 and is due at time of service.
Orig. 8.4.2010 - Rev. 2/2011, 2/2012 8/2013, 3/2014, 12/2014