Final grade must be offi cially posted on student’s Penn College transcript before course information can be
submitted to PDE for Act 48 credit.
Name __________________________________________________________________________________________________________________
Last First Middle Former last name
Home address _______________________________________________________________________________________________
Street/PO box/Apt. #
__________________________________________________________________________________________________________________________
City State ZIP code
Primary phone____________________________________ Email ____________________________________________________
Penn College student ID # ____________________________________________________________________________________
Professional personal ID # ____________________________________________________________________________________
Local Educational Agency/District
Name __________________________________________________________________________________________________________________
Address _____________________________________________________________________________________________________
Street/PO box/Apt. #
__________________________________________________________________________________________________________________________________
City State ZIP code
Course Information
Additional courses listed on back.
Act 48 Submission Request –
Credit Courses
Send to: Registrar’s Of ce, DIF #114
Pennsylvania College of Technology
One College Avenue
Williamsport, PA 17701-5799
registrar@pct.edu
PC 2279 4/20
Student signature ______________________________________________________________ Date ________________________
Course Number Course Title
No. of Credits
Earned
Semester &
Year Completed
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