ACT 48 FORM - Bloomsburg University of Pennsylvania

REQUEST FOR ACT 48 TEACHER CERTIFICATION CREDIT REPORTING

Office of the Registrar 150 Student Services Center

INSTRUCTIONS: Students wishing to report completion of college level credit-bearing courses earned at Bloomsburg University to the Pennsylvania Department of Education (PDE) for Act 48 Teacher Certification should complete and sign this form and submit it to: Office of the Registrar, 150 Student Services Center, Bloomsburg University, 400 East Second Street, Bloomsburg, PA 17815. *When completing this form, you MUST provide your Professional Personnel ID number; credits CANNOT be reported to the PDE without it.

1. Enrollment in the course and submission of this form does not indicate the course will fulfill Act 48 credit requirements. This determination is made by the student's school district/employer as to eligibility of specific college courses meeting Act 48 Requirements.

2. If a transcript is required for the school district/employer, a transcript request should be submitted to the Office of the Registrar. Transcript request instructions are available online at bloomu.edu/registrar-transcript-request

3. Credits earned prior to the CPE Period of the Educator (certification date) cannot be reported for Act 48 Credit and will not be accepted by the PDE.

PRINT (All information is REQUIRED)

Name: ______________________________________________________________ |____|____|____|____|____|____|____|

Last

First

Professional Personnel ID Number

Address: ________________________________________________ City: ________________________ State:______ Zip:___________

Email: _________________________________________ Phone Number: ____________________ BU ID# _______________________

Department & Course Info Title

*Sub Category

Semester/

# Credits Grade

Year Completed

|_________|-|___|___|___| _________________________________ ________________ ________________ ________ _______

|_________|-|___|___|___| _________________________________ ________________ ________________ ________ _______

|_________|-|___|___|___| _________________________________ ________________ ________________ ________ _______

|_________|-|___|___|___| _________________________________ ________________ ________________ ________ _______

|_________|-|___|___|___| _________________________________ ________________ ________________ ________ _______

*Choose a Sub Category from the list on the next page.

STUDENT'S SIGNATURE: ________________________________________________________ DATE: ________________ Authorizing release of information to PDE electronically via Internet

Students may check on the PDE website to determine if their college credits have been reported and if the PDE has accepted them.

Academic Content Studies Sub Categories:

Art

English

Business

Family & Consumer Sci

Civics & Gov

Foreign Language

Communication Geography

Early Childhood Health Education

Economics

History

Elementary Ed Library Science

Math Music Ed Reading Specialist Safety/Driver Education Science Special Education Vocational Instructional Cert

School Administration Sub Categories:

Data Analysis

School and Community Collaboration

Evaluation

School Leadership & Advocacy

School Law

Standards Based Systems (Theory & Design)

Standards Area Curriculum and Assessment Sub Categories:

Classroom Assessment

Data Analysis

Curriculum Development

Evaluation

Instructional Decision Making

Student Social and Health Issues Sub Categories:

CPR/First Aid

Educational Specialist

Drugs/Alcohol

Guidance Counseling

Resiliency School Nursing

Teaching and Learning Professional Development Sub Categories:

Behavioral Objectives/Discipline

OPEN Education (LSI Online)

Individualized Instruction

School & Community Collaboration

Interdisciplinary

Teaching Techniques and Strategies

Technology Sub Categories: Computer & Info Technology

Technology Education

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