Follow the steps to successfully complete your request form.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering your name in the designated field at the top of the form.
3. Fill in your Pennsylvania Department of Education (PDE) Professional ID number in the corresponding section.
4. Indicate your program status and current certification status in the specified fields.
5. Provide your complete address, including street, city, state, and zip code.
6. Input your daytime and evening phone numbers in the appropriate areas.
7. List the semester during which you completed the courses you are reporting.
8. For each course you wish to report, fill out the course number, course title, credits, and instructor in the designated rows.
9. Complete the school entity details by providing the contact person or office's name and phone number.
10. List the school entity name and street address along with the city, state, and zip code.
11. Sign the form to grant permission for Saint Joseph's University to report your completion of the listed courses.
12. Ensure to have the Certification Officer also sign the appropriate section.
13. Finally, include the date of signing and maintain a copy of this form for your records, as Saint Joseph's University will not retain a copy after submission.

Complete your document online today to ensure timely reporting of your course completions.