COMMONWEALTH OF PENNSYLVANIA
SEXUAL MISCONDUCT/ABUSE DISCLOSURE RELEASE
(Pursuant to Act 168 of 2014)
This standardized form has been developed by the Pennsylvania Department of Education, pursuant to Act 168 of 2014, to be used by
school entities and independent contractors of school entities and by applicants who would be employed by or in a school entity in a
position involving direct contact with children to satisfy the Act’s requirement of providing information related to abuse or sexual
misconduct. As required by Act 168, in addition to fulfilling the requirements under section 111 of the School Code and the Child
Protective Services Law (“CPSL”), an applicant who would be employed by or in a school entity in a position having direct contact with
children, must provide the information requested in SECTION 1 of this form and complete a written authorization that consents to and
authorizes the disclosure by the applicant’s current and former employers of the information requested in SECTION 2 of this form. The
applicant shall complete one form for the applicant’s current employer(s) and one for each of the applicant’s former employers that were
school entities or where the applicant was employed in a position having direct contact with children (therefore, the applicant may have
to complete more than one form). Upon completion by the applicant, the hiring school entity or independent contractor shall submit the
form to the applicant’s current and former employers to complete SECTION 2. A school entity or independent contractor may not
hire an applicant who does not provide the required information for a position involving direct contact with children.
Direct Contact with Children is defined as: “the possibility of care, supervision, guidance or control of children or routine interaction
Sexual Misconduct is defined as: “any act, including, but not limited to, any verbal, nonverbal, written or electronic communication or
physical activity, directed toward or with a child or a student regardless of the age of the child or student that is designated to establish
a romantic or sexual relationship with the child or student. Such acts include, but are not limited to: (1) sexual or romantic invitation; (2)
dating or soliciting dates; (3) engaging in sexualized or romantic dialogue; (4) making sexually suggestive comments; (5) self-disclosure
or physical exposure of a sexual, romantic or erotic nature; or (6) any sexual, indecent, romantic or erotic contact with the child or
Abuse is defined as “conduct that falls under the purview and reporting requirements of the CPSL, 23 Pa.C.S. Ch. 63, is directed
toward or against a child or a student, regardless of the age of the child or student.”
A prospective employer that receives any requested information regarding an applicant may use the information for the purpose of
evaluating the applicant’s fitness to be hired or for continued employment and shall report the information as appropriate to the
Department of Education, a state licensing agency, law enforcement agency, child protective services agency, another school entity or
to a prospective employer.
If the prospective employer decides to further consider an applicant after receiving an affirmative response to any of the questions listed
in SECTIONS 1 and 2 of this form, the prospective employer shall request that former employers responding affirmatively to the
questions provide additional information about the matters disclosed and include any related records. The Commonwealth of
Pennsylvania Sexual Misconduct/Abuse Disclosure Information Request can be used to request this follow-up information.
Former employers shall provide the additional information and records within 60 calendar days of the prospective employer’s request.
The completed form and any information or records received shall not be considered public records for the purposes of the Act of
February 14, 2008 (P.L. 6, No. 3) known as the “Right to Know Law.”
The Department of Education shall have jurisdiction to determine willful violations of Act 168 and may, following a hearing, assess a
civil penalty not to exceed $10,000. School entities shall be barred from entering into a contract with an independent contractor who is
found to have willfully violated the provisions of Act 168.