The Accreditation Services Division has compiled a group of sample forms utilized by various ASHP-accredited pharmacy technician training programs. Programs are welcome to download and modify the forms for use at their site. It is not mandatory for programs to use these forms. However, if used, the site must customize the form to include their own organization’s or school’s name/logo on the header, instead of the sample site. Programs can choose to customize the various elements of each form. Sample forms were contributed to ASHP in word or excel format as they are in use at the site.
Sample forms are made available so that programs do not have to reinvent the wheel. The sample forms are arranged online in order in which they are found to assist in record keeping for important requirements in the ASHP Standard for Pharmacy Technician Training Programs and for the Pre-survey Questionnaire for pharmacy technician training accreditation. Disclaimer: use of these forms does not guarantee ASHP accreditation.
| FORM NAME |
Credits |
Standard |
| Format of Advisory Committee Agenda |
STC [DOC] |
Part I |
| Format of Advisory Committee Minutes/Template |
STC [DOC]
VC [DOC] |
Part I |
| Roster of Advisory Committee Members |
SCC [DOC] |
Part I |
| Format of Advisory Committee Responsibilities Check-list |
MTI [DOC] |
Part I |
| Format of Program’s Strategic Plan/Implementation Management Grid |
BTC [DOC]
MTI [DOC]
ASUB [DOC] |
Part I |
| Format of Experiential Site and Pharmacy Service Qualifications |
BTC [DOC]
SCC [DOC]
VC [XLS] |
Part II, III, VII |
| Format of Preceptor Qualification |
VC [XLS]
MCT [DOC] |
Part IV, VII |
| Format of Student Curriculum and Training Plan |
VC [XLS]
STC [DOC] |
Part VII |
| Courses, labs, experiential rotations grid matched to ASHP Goals |
STC [DOC]
ASHP [DOC] |
Part VII |
| Format of Student Experiential Evaluations Performed by Preceptor |
STC [DOC]
STC [XLS] |
Part VII |
| Format of Student Experiential Rotation Evaluations Performed by Preceptor (behavioral) |
BTC [DOC]
STC [DOC] |
Part VII |
| Format of Experiential Rotation Evaluation Performed by Student |
BTC [DOC]
VC [XLS] |
Part VII |
| Experiential Rotation Timesheet |
STC [XLS] |
Part VII |
| Program Graduation Checklist |
VC [XLS] |
Part VI, IX |
STC—Southeastern Technical College
MTI—Midwestern Technical Institute
BTC—Bidwell Training Center
VC—Virginia College
ASUB—Arkansas State University-Beebe
SCC—St. Catharine College
MCT—Missoula College of Tech
ASHP would like to thank representatives from the following colleges for providing the sample forms:
- Arkansas State University-Beebe, Beebe, Arkansas
- Bidwell Training Center, Pittsburgh, Pennsylvania
- Midwestern Technical Institute, Springfield, Illinois
- Missoula College of Technology, Missoula, Montana
- Saint Catharine College, Saint Catharine, Kentucky
- Southeastern Technical College, Vidalia, Georgia
- University of Montana-Missoula College of Technology
- Virginia College at Austin, Austin, Texas
For further information, please feel free to contact Katrin Fulginiti (kfulginiti@ashp.org) or Lisa Lifshin (llifshin@ashp.org) in the ASHP Accreditation Services Division.