Request for ACT48 Credit/Hours

All fields except Course ID Number are required.

INSTRUCTIONS: Please complete this form and submit it through our secure web server to have your course information reported to Harrisburg for Act 48 hours.

Only credit courses and non-credit online courses are to be reported on this form. Non-credit face-to-face courses require completion of the "Act 48 Reporting Form" in the classroom with the instructor.

All fields must be completed in full.

PDE Personnel ID#
First Name *
Last Name *
Street Address
City
State
Zip
Email *
Daytime Phone
Course Name
Course ID Number
Course Type Credit Non-Credit (online courses only)
Total Course Hours (Non-credit only)
Course Start Date (Month & Year)            
Course End Date (Month & Year)            
Credits Awarded or Hours Attended