Fillable Education Approval Application: In Person Training (Pennsylvania Certification Board)

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Education Approval Application: In Person Training (Pennsylvania Certification Board)

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PCB | Education Approval Application for Organization: In Person Training | Revised September 2019 1
298 S. Progress Avenue, Harrisburg, PA 17109
Phone: 717-540-4455 Fax: 717-540-4458
www.pacertboard.org info@pacertboard.org
EDUCATION APPROVAL
APPLICATION
ORGANIZATION: IN PERSON TRAININGS
PCB | Education Approval Application for Organization: In Person Training | Revised September 2019 2
EDUCATION APPROVAL FOR IN PERSON TRAININGS
This application is for organizations seeking approval of trainings per training they offer. Individuals
seeking education approval for recertification need to complete the Individual Education Approval
Application for Recertification found at www.pacertboard.org
.
REQUIREMENTS FOR EACH TRAINING SUBMITTED FOR APPROVAL
1. $75 per course. (Unless PCB Provider.)
2. CV or Resume of trainer(s) unless they have been previously approved in the last 12 months.
3. Copy of the Evaluation Form.
4. A draft of any marketing material.
5. Summary of the training, goals and objectives and a detailed daily schedule. Colleges and
universities must submit the course syllabus.
REQUIREMENTS FOR THE ORGANIZATION
1. Provide a certificate of attendance to each attendee. The certificate must have the attendee’s
name, the exact title of the training listed on application, name of the organization, the date of
the training and the total number of hours awarded to each attendee. Do not change the title
or date of the training without notifying PCB in writing. You must indicate on the certificate
that the total hours awarded for the training are "PCB Approved Hours" (example: “PCB
Approved for 6 Hours”). If an attendee must leave the training prior to its completion, their
certificate of attendance must reflect the exact amount of time attended.
2. Within 10 days of completion of each PCB approved training, an attendance list including name
and email address or full address if there is no email address to PCB must be submitted. PCB
may randomly select attendees to inquire about the quality of the training.
3. Your organization may not advertise that a training is "pending PCB approval."
4. You must maintain attendance sheets for three years from training date of all PCB approved
trainings.
PCB RESERVES THE RIGHT TO APPROVE OR DENY EDUCATION BASED ON A
FULL REVIEW OF CONTENT AND INSTRUCTION.
TO SUBMIT YOUR APPLICATION, CHOOSE ONE OF THE FOLLOWING:
• EMAIL: education@pacertboard.org NOTE: Only PDFs are acceptable. PCB does not accept photos
of applications.
• FAX: 717-540-4458
• MAIL: PCB: 298 S. Progress Avenue | Harrisburg, PA 17109
Please allow 5-10 business days for review and processing of your application.
To confirm receipt of your application, or check on the status, you must email education@pacertboard.org.
PCB | Education Approval Application for Organization: In Person Training | Revised September 2019 3
EDUCATION APPROVAL APPLICATION IN PERSON TRAININGS
Form can be completed and saved. You may then print the appropriate pages to submit to PCB.
TYPE OR PRINT LEGIBLY
Name:
Email:
Please list the Sponsoring Organization or Company Name who is responsible for the training.
Website:
Please list the person who will be responsible for submitting trainings to PCB.
TRAINING INFORMATION
Title:
The title on your certificate of attendance must reflect the exact wording above.
Date of Training:
Location:
Total Hours:
City, State Exclude breaks, meals, etc.
PAYMENT INFORMATION: $75 FEE MUST ACCOMPANY APPLICATION
PAYMENT (CHECK ONE): □ Check □ Money Order □ VISA □ MasterCard □ Discover □ American Express
Checks & Money Orders made payable to PCB
Email address for receipt (credit card only): _____________________________________________________
TO SUBMIT YOUR APPLICATION, CHOOSE ONE OF THE FOLLOWING:
• EMAIL: education@pacertboard.org NOTE: Only PDFs are acceptable. PCB does not accept photos of applications.
• FAX: 717-540-4458
• MAIL: PCB: 298 S. Progress Avenue | Harrisburg, PA 17109
Address:
City:
State:
Zip:
Contact Person:
Email:
Name(s) and Credential(s) of Instructor(s):
Number:
-
-
-
Sec. Code:
Exp. Date:
Name on Card:
Billing address:
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Education Approval Application: In Person Training (Pennsylvania Certification Board)

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Completed 3 June 2021

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