CY 113 12/15
INSTRUCTIONS TO COMPLETE THE
PENNSYLVANIA CHILD ABUSE HISTORY CERTIFICATION APPLICATION:
• Type or print clearly and neatly in ink only.
• If obtaining this certification for non-volunteer purposes or if, as a volunteer having direct volunteer contact with children, you have
obtained a certification free of
charge within the previous 57 months, enclose an $13.00 money order or check for each application. No
cash will be accepted. Personal, agency, or business checks are acceptable. Certifications for the purpose of “volunteer having direct
volunteer contact with children” may be obtained free of charge once every 57 months. If no payment is enclosed for a non-volunteer
purpose, you must provide a payment authorization code, otherwise your application will be rejected and returned to you.
• DO NOT SEND POSTAGE PAID RETURN ENVELOPES for us to return your results. Results are issued through an automated system
generated mailing process.
• Certification results will be mailed to you within 14 days from the date the certification application is received at the ChildLine and Abuse
• Failure to comply with the instructions will cause considerable delay in processing the results of an applicant’s child abuse history
Purpose of Certication - Do not check more than one box:
• Check the foster parent box if applying for purposes of providing foster care.
• Check the prospective adoptive parent box if applying for the purpose of adoption.
• Check the employee of child care services box if applying for the purpose of child care services in the following:
- Child day care centers; group day care homes; family day care homes; boarding homes for children; juvenile detention center services or
programs for delinquent or dependent children; mental health services for children; services for children with intellectual disabilities; early
intervention services for children; drug and alcohol services for children; and day care services or other programs that are offered by a school.
• Check the school employee governed by the Public School Code box if you are a school employee who is required to obtain
background checks pursuant to Section 111 of the Public School Code and will continue to be required to obtain background checks prior
to employment in accordance with that section and on the periodic basis required by Act 153.
• Check the school employee not governed by the Public School Code box if you are a school employee not governed by Section 111
of the Public School Code, but covered by Act 153 (pertaining to school employees in institutions of higher education).
Denition of school employee: A school employee is dened as an individual who is employed by a school or who provides a program,
activity or service sponsored by a school. The term does not apply to administrative or other support personnel unless they have direct
contact with children.
Denition of school: A facility providing elementary, secondary or postsecondary educational services. The term includes the following:
(1) Any school of a school district.
(2) An area vocational-technical school.
(3) A joint school.
(4) An intermediate unit.
(5) A charter school or regional charter school.
(6) A cyber charter school.
(7) A private school licensed under the act of January 28, 1988 (P.L.24, No. 11), known as the Private Academic Schools Act.
(8) A private school accredited by an accrediting association approved by the state Board of Education.
(9) A non-public school.
(10) An institution of higher education.
(11) A private school licensed under the act of December 15, 1986 (P.L. 1585, No. 174), known as the Private Licensed Schools Act.
(12) The Hiram G. Andrews Center.
(13) A private residential rehabilitative institution as dened in section 914.1-A(c) of the Public School Code of 1949.
• Check the self-employed provider of child-care services in a family child-care home if providing child care services in one’s home
(other than the child’s own home) at any one time to four, ve, or six children who are not relatives of the caregiver.
• Check the individual 14 years of age or older who is applying for or holding a paid position as an employee box if the employment
is with a program, activity, or service, as a person responsible for the child’s welfare or having direct contact with children:
Applying as an employee who is responsible for the child’s welfare or having direct contact (providing care, supervision, guidance, or
control to children or having routine interaction with children) in any of the following in which children participate and which is sponsored
by a school or public or private organization:
- A youth camp or program;
- A recreational camp or program;
- A sports or athletic program;
- A community or social outreach program;
- An enrichment or educational program; and
- A troop, club, or similar organization
• Check the individual seeking to provide child care services under contract with a child care facility or program box if you are
providing child care services as part of a contract or grant funded program.
• Check the box for individual 18 years or older who resides in the home of a foster parent for at least 30 days in a calendar year if
you are an adult household member in this setting and require certication.
• Check the box for individual 18 years or older who resides in the home of a certied or licensed child-care provider for at least 30
days in a calendar year if you are an adult household member in this setting and require certication.