Pharmacy Technician Training Interest Form
Thank you for your interest in our Pharmacy Technician Training Program.
Cohorts meet Mon-Thur 6:00pm to 8:00pm (Virtual) and Three Saturdays (In-Person) Time TBD
Please complete this form to help us understand your background and interest in the program.
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First and Last Name *
Email Address *
Mobile Number 
(Please use dash format {123-456-7890})
 *
Ethnicity/Race *
Gender *
Age *
 Where do you live? CITY/STATE *
Highest Level of Education Completed: *
Which of the following best describes your current or past connection with Chicago Public Schools?
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If you are a current CPS student, which school do you attend?
Current Employment Status: *
What interests you about the Pharmacy Technician Training Program? *
Do you have any prior experience in healthcare or pharmacy-related fields? *
If yes, please describe your experience

What are your career goals after completing the program?

 *
Are you available to commit to the full duration of the training program? Monday through Thursday, 6:00pm to 8:00pm (Virtual) and three Saturdays (In-Person)
 *
Do you require any accommodations to participate in the program?
 *
If yes to the above question, please list the any accommodations.
How did you hear about this program?
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I understand that I must pay in full the tuition prior to training. $250.00. *
Required
I consent to receive SMS text messages from Greater Opportunities Inc. regarding program updates, scheduling, and important notifications. Message and data rates may apply. My information will be kept confidential and will not be sold or shared with any third party. I understand I can opt out at any time by replying STOP. *
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