Get Ca 17a-89 2016-2026

Filling out the CA 17A-89 application form is an essential step for individuals seeking an advanced practice pharmacist license in California. This guide provides clear instructions to help you complete the online process efficiently and accurately.

Follow the steps to effectively complete the CA 17A-89 form.

1. Click ‘Get Form’ button to obtain the CA 17A-89 application form and open it in your chosen online editor.
2. Begin by entering your personal information. Provide your full legal name, California pharmacist license number, and contact details, including your home and work telephone numbers.
3. Indicate your current status regarding military service. You must specify if you are currently serving, are a veteran, or if your spouse or partner is actively serving in the military.
4. Select the qualification methods that apply to you. You can choose from certification in a relevant area of practice, completion of a postgraduate residency, or clinical experience providing at least 1,500 hours of clinical services.
5. List the types of services you anticipate providing. This section is voluntary, but detailing these services can be beneficial for your application.
6. Review your application carefully to ensure all required fields are completed. If a question is not applicable, indicate this by writing 'N/A'.
7. Sign and date the application. Please ensure that your signature is the original and not a photocopy or electronic version.
8. Prepare your application fee of $300 and attach a check or money order made payable to the Board of Pharmacy.
9. Submit your completed application along with any supporting documents required, such as military service evidence or proof of clinical experience.
10. Once everything is reviewed and complete, save your changes, download the form, or print a copy for your records before submitting it online.

Start filling out your CA 17A-89 application online for a smooth application process.