Technician Trainee Application

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Waiver of Fee -- Determination of Eligibility

Technician Trainee

Iowa Regulations

Disclosure of Medical Conditions, Criminal History, and Disciplinary Action


Medical Condition

Medical Condition

Required Documents

Military or Veteran Status

Prior Iowa Board of Pharmacy Licensure or Registration

Personal Information

Home/Permanent Address

Alternate Mailing Address (optional)

Contact Information

Current Employment

Other State Professional Licenses or Registrations

Criminal History

Disciplinary Actions/History

Professional License/Registration Denials

Pending Investigations

Required Document(s)


Confirm and Submit


Physical and Mailing Address: 6200 Park Avenue, Suite 100, Des Moines, IA 50321-1270. (P): (515) 281-5944 (F): (515) 281-4609