Request to Report Credits to
Pennsylvania Department of Education
as required under Act 48 of 1999 Professional Education Commonwealth of Pennsylvania
STUDENT_INFORMATION:
Student ID: @ ___________________________ *(Required) PDE Professional ID: _____________ * This form cannot be submitted to the PDE without your PDE ID#. PDE assigns a unique ID to individuals who receive certification. Name: Last ______________________________________First ___________________________________________M.I. ______
Home Address: ____________________________________________________________________________________________
Street
City
State
Zip Code
Home Phone: _____________________Cell Phone: ____________________Email: ____________________________________
REQUIRED_SIGNATURE:
I affirm that the information provided below is true and accurate. Furthermore, I give Edinboro University permission to submit any
information contained on this form to the Pennsylvania Department of Education for entry into the ACT 48 database.
Student Signature:
Date:
EDINBORO_UNIVERSITY_CREDIT-BEARING_COURSE(S): All information below is required. The course cannot be
submitted to PDE without all of the information below. Please see second page for PDE Codes.
PDE Course/Activity PDE Course /Activity Course Subject Course Credits Semester Final
Subject_Area_Code*___Subcategory_Code_____and_Number______Title___________________Earned ______Taken______Grade Ex. 7 C EDUC 788 Research in Education 3 Fall 2010 A 
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Mail or Fax Completed Form to: Office of Records and Registration, Edinboro University, Hamilton Hall, 210 Glasgow
Rd, Edinboro, PA 16444, Fax: 814.732.2130, Phone: 814.732.5555
Continued
Created: 08/02/2006
Revised: 02/17/2014
INSTRUCTIONS FOR CODE SELECTION FOR ACT 48 REPORTING: 1. Choose Subject Area for each course you are requesting to report to PDE and enter Code in designated area on previous page.
2. Choose Subcategory for the selected Subject Area and enter Code for each course in designated area on previous page.
3. Only one Subject Area and one Subcategory code can be selected for each course.
PDE COURSE/ACTIVITY SUBJECT AREA:
Code Category
1
Academic Content Studies
2
PA Inspired Leadership (PIL)
3
PA Inspired Leadership (PIL) Induction
4
School Administration (Non-PIL)
5
Standards Area Curriculum and Assessment
6
Student Social and Health Issues
7
Teaching and Learning Professional Development
8
Technology
PDE COURSE/ACTIVITY SUBCATEGORY:
1. Academic Content Studies
Code Subcategory
A
Art Education
B
Business
C
Civics and Government
D
Communication
E
Early Childhood
F
Economics
G
Elementary Education
H
English
I
Family and Consumer Science
J
Foreign Language
K
Geography
L
Health and Physical Education
M
Health Education
N
History
O
Library Science
P
Mathematics
Q
Music Education
R
Reading Specialist
S
Safety/Driver Education
T
Science
U
Special Education
V
Vocational Instructional Certification
2. PA Inspired Leadership (PIL)
Code Subcategory
A
Advocating for Children and Public Education – CL5
B
Building a Learning Community – CL3
C
Creating a Culture for Learning – CL1
D
Data Analysis and Decision Making – CR3
E
Ethical Practices – CL4
F
Managing Resources for Effective Results – CL2
G
Professional Growth/Practice and Inquiry – CL6
H
Standards-Based Systems – CR2
I
Strategic Thinking and Planning – CR1
3. PA Inspired Leadership (PIL) Induction
Code Subcategory
A
Data Analysis and Decision Making – CR3
B
Standards-Based Systems – CR2
C
Strategic Thinking and Planning – CR1
Created: 08/02/2006
Revised: 02/17/2014
4. School Administration (Non-PIL)
Code Subcategory
A
Data Analysis
B
Evaluation
C
School and Community Collaboration
D
School Law
E
School Leadership and Advocacy
F
Standards Based Systems (Theory and Design)
5. Standards Area Curriculum and Assessment
Code Subcategory
A
Classroom Assessment
B
Curriculum Development
C
Data Analysis
D
Evaluation
E
Instructional Decision Making
6. Student Social and Health Issues
Code Subcategory
A
CPR/First Aid
B
Drugs/Alcohol
C
Educational Specialist
D
Guidance Counseling
E
Resiliency
F
School Nursing
7. Teaching and Learning Professional Development
Code Subcategory
A
Behavioral Objectives/Discipline
B
Individualized Instruction
C
Interdisciplinary
D
OPEN Education (LSI Online)
E
School and Community Collaboration
F
Teaching Techniques and Strategies
8. Technology
Code Subcategory
A
Computer and Information Technology
B
Technology Education