Pharmacy Technician Continuing Education Credit Claim Form
Submit your details to claim continuing education credits as a pharmacy technician. Please complete all fields relevant to your credit claim.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Pharmacy Technician License/Registration Number
*
State of Licensure
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
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Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
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Montana
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New Hampshire
New Jersey
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New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
Course Title
*
Course Provider
*
Date of Course Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of Credits Claimed
*
Upload Proof of Completion (Certificate or Transcript)
*
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