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Pharmakeia's Enrollment Agreement Form

Thank you for applying to our Certified Pharmacy Technician Program. In order to complete the registration process, payment must be submitted. 


Note:  This program is PTCB Recognized Education and is Approved and Regulated by the Colorado Department of Higher Education, Private Occupational School Board

Student Information

Birthday
Month
Day
Year
Select preferred method of communication
How did you hear about it us?
Do you have High School Diploma or GED?
Yes
No

*Note this program requires high school diploma or equivalent

Have you ever been convicted of felony, misdemeanor or of any drug related offense?
Yes
No

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