Fillable The Individual Education Approval Form (Pennsylvania Certification Board)

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The Individual Education Approval Form (Pennsylvania Certification Board)

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PCB | Education Approval Application for Organization: Individual | 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
INDIVIDUAL: FOR RECERTIFICATION
PCB | Education Approval Application for Organization: Individual | Revised September 2019 2
EDUCATION APPROVAL FOR RECERTIFICATION INFORMATION
FOR ALL PROFESSIONALS SEEKING EDUCATION APPROVAL
1. An education approval application can be submitted at the time of recertification or when a
training is completed.
2. A professional will be notified of approval via email only no more than 30 days after submission.
3. PCB does not accept general staff meetings, supervision, staff rounds, case management as
education, or time spent sponsoring others as education.
4. PCB reserves the right to determine how many hours will be granted, which may differ from the
hours of the granting organization.
5. PCB reserves the right to deny approval of any training or college/university course.
HOW DO I KNOW IF I NEED EDUCATION APPROVAL?
If your certificate of attendance does not say “PCB Approved Hours”, you attended an out-of-state
training, or you are using a college/university course, it is likely you will need to seek PCB Approval for
your education. Prior to submitting for education approval, you should search PCB’s website to see if
your training is listed. If your out-of-state education was approved by an IC&RC member board of that
state, no further PCB approval is necessary. Proof of the IC&RC member board approval must be
submitted. If you have a CPS (Peer), CRS, or CFRS your education does not require education approval.
REQUIRED DOCUMENTATION
1. Certificate of attendance: must include attendee name, training title, date of training, number
of hours and sponsoring organization.
2. Documentation from organization: must include title of training, description of training
content, date, presenter and name of sponsoring organization.
3. Online Training: the entire course must be submitted for review. If the training did not have a
post-test, it will not be approved.
4. College/University Course: a syllabus or course content and copy of the transcript must be
included. Only courses from an accredited college or university that is recognized by the US
Department of Education or the Council on Higher Education Accreditation will be approved.
5. Trainers: If you were the trainer, include a letter from sponsoring organization verifying the
date, title, and length of training. Trainers receive the same number of hours as the attendees.
6. Published Work: work written by the certified professional and published by a professional
publishing house may meet up to 10 hours of education. A copy of the work must be submitted.
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
PCB | Education Approval Application for Organization: Individual | Revised September 2019 3
EDUCATION APPROVAL APPLICATION FOR INDIVIDUALS
Form can be completed and saved. You may then print the appropriate pages to submit to PCB.
TYPE OR PRINT LEGIBLY
USE ONE FORM PER TRAINING OR COLLEGE/UNIVERSITY COURSE
TYPE OF EDUCATION: □ In Person □ Online □ College/University Course □ Trainer □ Published Work
Date Submitted:
Credential Expiration Date:
TRAINING INFORMATION
Sponsoring Organization:
Title:
Date of Training:
Location:
Total Hours:
City, State or Online
PAYMENT INFORMATION: FEE MUST ACCOMPANY APPLICATION
EDUCATION APPROVAL FEES (CHECK ONE): □ $10 for one training
□ $20 for two or more trainings submitted at the same time
□ $30 for published works
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
Number:
-
-
-
Sec. Code:
Exp. Date:
Name on Card:
Billing address:
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The Individual Education Approval Form (Pennsylvania Certification Board)

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Completed 3 June 2021

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