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COLLEGE/UNIVERSITY VERIFICATION FORM PDE 338 ACompletion of Approved Education Program

For Use by Applicants Prepared by NON-PA Colleges/Universities(Refer to instructions included with this form)

APPLICANTS: Please note the following information in regard to your Social Security Number (SSN)

DATA REQUIRED BY THE FEDERAL PRIVACY ACT (5 U.S.C. Section 552a note)

AUTHORITY: 24 P.S. Section 1224.PURPOSE(S): To be used for (1) registration and maintenance of records of all certificated persons as having met qualifications for teaching, (2) identification and

collection of criminal/disciplinary records for certified educators and candidates for certification and (3) provision of certification data to authorized personnel a

agencies.

DISCLOSURE: Mandatory. Failure to disclose will prevent further processing of the application.

SECTION I - APPLICANT INFORMATION (please print or type)Last Name First Name Middle Initial Social Security Number

Address City State Zip Code

SECTION II - EDUCATION CERTIFICATION PROGRAM INFORMATION

1. Name of the academic program completed: _____________________________________________

2. Was the academic program listed above an alternative route to certification?

Yes No

3.

____________________________ ____________ Major Minor ________________________Subject Grade Levels Date Program Completed

_____________________________ ____________ Major Minor ________________________

Subject Grade Levels Date Program Completed

SECTION III - PREPARING COLLEGE/UNIVERSITY RECOMMENDATION

1. I verify that I am the appropriate, authorized person, as designated by this college/university, to

verify a students education certification program.__________

Initial

2. I verify that the college/university had state approval to prepare educators in the subject area and

grade levels indicated above at the time the student completed this program.__________

Initial

3. I recommend this student as having completed our state-approved certification program as listed

above. (Testing, or out of state certification/licensure are not mandatory for recommendation)__________

Initial

4. To the best of my knowledge and belief, the candidate is known and regarded by the preparing

institution as a person of good moral character and possesses those personal qualities and professionalknowledge and skill which warrant issuance of the requested certificate. (If the certification officer

possesses information which prevents verification of the good moral character of the candidate, a

statement of explanation must be attached to the 338 A form).

__________

Initial

SECTION IV - CERTIFICATION OFFICIAL INFORMATION

_______________________________________ _____________________________________________ Name of College/University Address of College/University

____________________________________ ____________________________________________

Telephone Number Email Address

____________________________________ ______ _______________________ __________Signature of Certifying Official Name & Title Date

PDE 338 A (Revised 07/

Affix Official Seal

Here

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INSTRUCTIONS FOR COLLEGE/UNIVERSITY VERIFICATION FORM PDE 338 APRINT WITH DARK BLUE OR BLACK INK

SECTION I: Applicant Information

1. Print or type your Last Name, First Name, Middle Initial, Social Security Number and current address.

2. Send this form and instruction sheet to your college/university certification officer.

3. The PDE 338A form is an important part of your application packet. The form indicates that you havecompleted a state-approved teacher education program and may qualify you for certification under the

interstate agreement.

After this form is completed by the college/university certification officer it should be returned to you.

Check the information documented on 338 A form for accuracy and completeness before adding it

to your application packet.

4. In your application packet, include photocopies of certificates/licensures held during the entire time

frame in which the teaching experience documented on the 338 V Form occurred.

SECTION II: Certification Program Information

(Section II must be completed by the certification officer- not the applicant)

1. Print the name of the academic program the applicant has completed.2. Indicate whether the academic program was an alternative route to certification by checking either the

yes or no box.

3. Print the Subject and Grade levels, and indicate whether the program was a Major or Minor by checkingeither the Major or Minor box. Print the date the program was completed.

SECTION III: Preparing College/University Recommendation

(Section III must be completed by the certification officer- not the applicant)

1. Verify that you are the college/universitys authorized certifying official by entering your initials in the box provided.

2. Verify that the college/university is state-approved to offer the teacher preparation program completedby the applicant by entering your initials in the box provided.

3. Recommend the applicant for certification by entering your initials in the box provided. Please note, anindividual may be recommended even if he or she did not complete the test/s required for program

completion.

NOTE: Colleges and Universities may recommend only for subject/fields and type certificates for

which program approval has been granted. Candidates recommended for a Letter of Eligibility, anAdministrative I or Supervisory I certificate must meet the established experience requirement as

evaluated by the Bureau of School Leadership & Teacher Quality, before the certificate is issued. The

Statements of Verified and Attested service, Form PDE 338 V, should accompany the application

packet.

4. Please initial the box provided to indicate that the institution is currently unaware of any information thatthe educator does not possess good moral character. If the institution is aware of information which

prevents attestation of the good moral character of the candidate, a letter of explanation must be included

with the PDE 338 A form.

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SECTION III: Certifying Official Information

1. Print the Name of the College/University and the Address of the institution. Print the telephone number

and/or Email address where you may be contacted. Sign the application and print your Title, and date of

signature. Affix an official college/university seal.

2. Return the form to the applicant. Do not return the PDE 338 A form to the Bureau of School

Leadership and Teacher Quality.