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Pharmacy Technician Accreditation

Sample Pharmacy Technician Training Program Forms

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.

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Frequently Asked Questions [PDF]

ASHP Member Center for Technicians

 

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