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California State Board of Pharmacy

2720 Gateway Oaks Drive, Suite 100

Sacramento, CA 95833

Phone: (916) 518-3100 Fax: (916) 574-8618

www.pharmacy.ca.gov

Business, Consumer Services and Housing Agency

Department of Consumer Affairs

Gavin Newsom, Governor

PHARMACY TECHNICIAN APPLICATION INSTRUCTIONS

HOW LONG WILL IT TAKE TO PROCESS MY APPLICATION?

➢ Allow the board 45 days to process your application.

➢ The board will notify you by mail if your application is not complete.

➢ Please do not contact the board to check on your application unless it has been on file for over 60

days.

➢ If your check has cleared your bank, the board has received your application.
➢ To check if your license was issued, go to www.pharmacy.ca.gov. Select “Verify a License” and enter

your name. It takes four to six weeks from the date a license is issued to receive the physical license
in the mail.

WHAT MAKES AN APPLICATION COMPLETE?

Please review 1-8 below to be sure your application is complete before mailing it to the board.

If your application is not complete, you will receive a “Deficiency Letter” in the mail.

•

• You will then have 60 days to submit the required item(s).

•

If you do not submit the required item(s) within 60 days, you may have to file a new application with

new fees and meet any new requirements.

1. APPLICATION FEE IS $195:

When you send your application, include a check or money order made payable to the California State

Board of Pharmacy. The application fee is non-refundable.

2. APPLICATION FOR A PHARMACY TECHNICIAN LICENSE (form 17A-5 (rev. 10/15): Complete the entire

application.

AVOID COMMON MISTAKES

• The name on each form must be EXACTLY THE SAME as the name on your state driver’s license or

state-issued identification card. Your name must be the same on each of the following documents:

✓ Pharmacy Technician Application,
✓ Request for Live Scan form or fingerprint cards, and

✓ Self-Query Report.

• Have you ever used a different name? List each prior name on the application under Previous Names.

✓ Did you have a maiden name, married name, former name, AKA?

✓ Have you ever used Jr., Sr., II, etc., with your name?

✓ If you do not list all of your previous names, the board may not locate, match or verify your

documents.

• Do not leave anything blank; use “N/A” if a question doesn’t apply to you.

• Do not let your school fill out Pages 1, 2 and 3 of your application.

• You must sign and date the application. No one else can sign it for you. Signatures must be original and

dated within 60 days of filing the application. No electronic signatures will be accepted.

17A-7 (REV 7/2020)

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California State Board of Pharmacy

2720 Gateway Oaks Drive, Suite 100

Sacramento, CA 95833

Phone: (916) 518-3100 Fax: (916) 574-8618

www.pharmacy.ca.gov

Business, Consumer Services and Housing Agency

Department of Consumer Affairs

Gavin Newsom, Governor

3. U.S. Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN): Disclosure of your

U.S. social security number (SSN) or Individual Taxpayer Identification Number (ITIN) is mandatory and must

be included on the application and on the Self-Query Report.

4. PHOTO: Please attach a passport-style photo to page 1 of the application (2”x2” glossy color photo) taken

within 60 days of filing the application. DO NOT provide scanned images, Polaroids, or black-and-white
photos.

5. BASIC EDUCATION: You must be a high school graduate or have a general education development

certificate equivalent.

Attach ONE of the following (A, B, C, D, or E):

A. U.S. High School Graduate: Attach an official, embossed transcript (academic record) or notarized copy
of your high school transcript. It must have the graduation date on it. To get a copy of your high school

transcript, contact your high school or its school district office.

B. Foreign High School Graduate: Attach a notarized copy of your foreign secondary school diploma or

certificate OR a notarized copy of your foreign secondary school transcripts. If not in English, then

include a certified translation in English. The translation may be from an evaluation service that states
your education is equal to graduating high school in the U.S.

C. High School Equivalency: (Attach 1, 2, or 3 to show documentation of completing one of the three High

School Equivalency Tests.)

1. General Educational Development (GED): Attach an official transcript of your test results or

equivalent. GED test results are official only if they are earned through an authorized GED Testing
Center. To get your GED transcripts, go to http://www.gedtestingservice.com/testers/gedrequest-

a-transcript. If your GED is from another state, you may need to request an official transcript of

your GED test results from the agency in that state.

2. HiSET: Attach an official transcript of your test results or equivalent. HiSET test results are official

if they are earned through an authorized HiSET Testing Center. To request your HiSET transcripts,
go to www.diplomasender.com.

3. TASC: Attach an official transcript of your test results or equivalent. TASC test results are official if

they are earned through an authorized TASC Testing Center. To request your TASC transcripts, go

to http://www.tasctest.com/.

D. Certificate Equivalent – Attach an official “Certificate of Proficiency” showing you passed the California

High School Proficiency Examination (CHSPE). To request a copy, go to https://www.chspe.net/cert-

trans/ or call (866) 342-4773.

E. Out-of-State High School General Educational Development Certificate Equivalent: Attach an official

transcript of your test results or equivalent.

17A-7 (REV 7/2020)

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California State Board of Pharmacy

2720 Gateway Oaks Drive, Suite 100

Sacramento, CA 95833

Phone: (916) 518-3100 Fax: (916) 574-8618

www.pharmacy.ca.gov

Business, Consumer Services and Housing Agency

Department of Consumer Affairs

Gavin Newsom, Governor

6. PHARMACY TECHNICIAN DOCUMENTS: Attach ONE of the following (A, B, C, or D):

A. Affidavit of Completed Coursework or Graduation for Pharmacy Technician (17A-5 rev 10/15): The

program director, school registrar or pharmacist must complete and sign the affidavit on Page 4. Copies
or stamped signatures are not accepted. The school seal must be embossed on the affidavit and/or you

must attach a pharmacist’s business card with license number. An affidavit is required for one of the

following:

• Associate Degree in Pharmacy Technology;

• Any other course that provides a training period of at least 240 hours of instruction as specified in

Title 16 California Code of Regulation section 1793.6(c);

• Training course accredited by the American Society of Health-System Pharmacists (ASHP);

• Graduation from a school of pharmacy accredited by the Accreditation Council for Pharmacy

Education (ACPE).

B. Pharmacy Technician Certification Board (PTCB) certified: Submit a copy of your PTCB certificate.

C. National Healthcare Association Pharmacy Technician Certification Program (ExCPT): Submit a copy of

your ExCPT certificate. Effective January 1, 2017, the Board will accept ExCPT certifications dated On or

After January 1, 2017. ExCPT certifications received prior to January 1, 2017 will not be accepted.

Please check the box on the application on page 1 under the Pharmacy Technician Qualifying Method

“Attached is a certified copy of PTCB certificate program”. By checking this box this will identify your
application as applying under a certification program.

D. Military Training: Submit a copy of your DD214 documenting evidence of your pharmacy technician

training provided by a branch of the federal armed services.

7. SELF-QUERY REPORT: Include a sealed, original Self-Query Report from the National Practitioner Data Bank

(NPDB). It must be dated within 60 days of filing the application.

• Self-Query Reports that have been opened will not be accepted.

• The name on your Self-Query Report must be EXACTLY THE SAME as the name on your application.

• You must include your US social security or ITIN number when completing your Self-Query Report.

• To request a Self-Query Report, go to the NPDB’s Web site at http://www.npdb.hrsa.gov/ or the direct

link is https://www.npdb.hrsa.gov/ext/selfquery/SQHome.jsp

• NPDB’s contact number (800) 767-6732 or TDD (703) 802-9395. Their Web site has a fact sheet and

answers to frequently asked questions. The board is not able to assist you with requesting the Self-

Query Report. For help, contact the NPDB directly.

• You must pay the fee directly to NPDB.

• You must submit a new Self-Query Report even if one was submitted with a previous application.

8. FINGERPRINTS:

• California residents must use Live Scan. Nonresidents can visit California to complete a Live Scan or

submit fingerprints on cards supplied by the Board. The fingerprint cards must be processed at a

location authorized to complete fingerprint cards for the DOJ/FBI (e.g. law enforcement agency) in the

state the services are rendered.

• DO NOT complete the Live Scan service or fingerprint cards until you are ready to send your application.

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California State Board of Pharmacy

2720 Gateway Oaks Drive, Suite 100

Sacramento, CA 95833

Phone: (916) 518-3100 Fax: (916) 574-8618

www.pharmacy.ca.gov

Business, Consumer Services and Housing Agency

Department of Consumer Affairs

Gavin Newsom, Governor

• You must submit a copy of your Live Scan receipt or new fingerprint cards with your application.

• Each application requires you to complete a new Live Scan or submit new fingerprint cards.

• The Live Scan site may charge a processing fee.

• The board will accept fingerprint responses only from the California Department of Justice (DOJ) and

Federal Bureau of Investigation (FBI).

Please complete and attach ONE of the following (A or B):

A. California Resident: Attach completed Live Scan receipt. The receipt shows you completed the Live

Scan.

• California residents must use Live Scan only.

• To find a Live Scan location, go to https://oag.ca.gov/fingerprints/locations

• Live Scan operators can make mistakes. You must be sure everything on the form is correct.

Make sure the following information is correct when you complete your Live Scan:

• Type of License/Certification/Permit or Working Title: Pharmacy Tech-Sect 4015

• Full Name: Must be EXACTLY THE SAME as the name on your state driver’s license or state-issued

identification card (Jr., II, etc., must be included). It must also be EXACTLY THE SAME as the name

on your application and Self-Query Report.

• Date of Birth: Must be correct.

• Social Security Number: Must be included and be correct, unless you have an ITIN. If you have an

ITIN, enter this number in the SSN field.

• Level of Service: Must include both DOJ and FBI.

B. Non-California Resident: You may visit California and complete Live Scan. If you cannot, then you

must send two rolled fingerprint cards.

• You must use fingerprint cards from the Board of Pharmacy.

• Request fingerprint cards through the board’s online services at

https://www.dca.ca.gov/webapps/pharmacy/pubs_request.php or email rxforms@dca.ca.gov.

• Fee: Include fingerprint card processing fee of $49 ($32 DOJ and $17 FBI), made payable to the

Board of Pharmacy.

• You can send one check or money order for both the application processing fee and fingerprint

card processing fee.

• Print legibly or type your personal information on the fingerprint cards. If your personal

information is not legible and DOJ enters your information incorrectly, you will be responsible to

submit new fingerprint cards and pay the $49 fingerprint card processing fee again.

• The fingerprint cards must be processed at a location authorized to complete fingerprint cards for

the DOJ/FBI (e.g. law enforcement agency) in the state the services are rendered.

• Fingerprint clearances from cards take about six weeks longer than Live Scan.

• Poor quality prints will be rejected and will cause delay because new fingerprint cards will be

required.

17A-7 (REV 7/2020)

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California State Board of Pharmacy

2720 Gateway Oaks Drive, Suite 100

Sacramento, CA 95833

Phone: (916) 518-3100 Fax: (916) 574-8618

www.pharmacy.ca.gov

Business, Consumer Services and Housing Agency

Department of Consumer Affairs

Gavin Newsom, Governor

MILITARY/REFUGEE EXPEDITE

MILITARY EXPEDITE: The board will expedite review of an application that meets one of the following criteria.

Please check the appropriate box and submit this page with your completed application.

____ SERVING IN THE MILITARY: Are you currently serving in the United States military?

 Attach a copy of your military identification.

____ VETERAN: Have you served in the United States military?

 Attach a copy of your DD214 with your application.

____ ACTIVE DUTY MILITARY – SPOUSE OR PARTNER: If your spouse or partner is an active duty member of

the U.S. Armed Forces and you hold a current license in another state, please provide the following:

 Attach a copy of your current license in another state, district, or territory of the United States

documenting the profession or vocation for which you seek license from the board.

 Attach a copy of the marriage certificate, or certified declaration/registration of domestic

partnership, or other evidence of legal union.

 Attach a copy of your spouse or partner’s military orders establishing duty station in California.

REFUGEE EXPEDITE: The board will expedite review of an application that meets one of the following criteria.

Please check the appropriate box and submit this page with your completed application.

____ You were admitted to the United States as a refugee pursuant to section 1157 of title 8 of the United

States Code;

____ You were granted asylum by the Secretary of Homeland Security or the United States Attorney General

pursuant to section 1158 of title 8 of the United States Code; or,

____ You have a special immigrant visa and were granted a status pursuant to section 1244 of Public Law

110-181, Public Law 109-163, or section 602(b) of title VI of division F of Public Law 111-8, relating to Iraqi and

Afghan translators/interpreters or those who worked for or on behalf of the United States government.

ACCEPTABLE DOCUMENTATION
• Form I-94, Arrival/Departure Record, with an admission class code such as “RE” (Refugee) or “AY”

(Asylee) or other information designating the person a refugee or asylee.

• Special immigrant visa that includes the of “SI” or “SQ.”

• Permanent Resident Card (Form I-551), commonly known as a “Green Card,” with a category

designation indicating that the person was admitted as a refugee or asylee.

• An order from a court of competent jurisdiction or other documentary evidence that provides

reasonable assurance that the applicant qualifies for expedited licensure.

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