The PDE 338 R-4 form plays a pivotal role for certified individuals in Pennsylvania facing challenges with their continuing professional development records, specifically in cases where there is a necessity to appeal a Notice of Inactive Certification. This essential document, crafted with precision to safeguard the rights and achievements of educators, requires detailed personal and professional information, including Social Security Number, to facilitate the appeal process efficiently. Ensuring accuracy and completeness in providing these details, along with pertinent supporting documents such as a copy of the teaching certificate and a concise statement outlining the grounds for the appeal, is crucial. The form stands as a testament to the structured process established by the Pennsylvania Department of Education for handling discrepancies or issues related to credit or hour reporting, emphasizing the importance of timely submission within a 30-day window following the receipt of a Notice of Inactive Certification. This procedure underscores the commitment to maintaining the integrity of the professional development records and provides a clear path for educators to rectify issues, ensuring that their certifications reflect their true educational achievements and qualifications.
| Question | Answer |
|---|---|
| Form Name | Form Pde 338 R 4 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | PDE, form 338, 3rd, R-4 |
REQUEST FOR APPEAL: ACT 48/ACT 45
FORM PDE 338
In accordance with §1205.2(i) of the Public School Code (Act 48 of 1999)
See Instructions on back of this form
PDE USE ONLY |
CONTROL NUMBER |
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. § 1224.
PRINCIPAL PURPOSE(S): To be used for maintenance of continuing education records of all certificated individuals.
ROUTINE USES: Used by the Pennsylvania Department of Education for the identification, evaluation, registration, and maintenance of continuing education records for certificated individuals.
DISCLOSURE: Voluntary. Withholding requested SSN may result in a delay of the initiation of the appeal process while the individual’s identity is verified and records are located.
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1. Last Name |
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1. First Name |
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2. Street Address
M4. Social Security Number
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Year |
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F |
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5. Date of Birth |
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6. Sex |
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2. City
2. State
2. Zip Code
3. Chronologically print former name(s) beginning with the most recent
Last Name |
First Name |
MI |
7. Home Phone
7. Daytime Phone
8. Reason for Appeal (check one) |
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□ Discrepancy in (credits/hours) reported to the Department. |
□ Other: |
(see back for details) |
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9.Criteria for Appeal: Please submit three copies of the following documentation for your appeal to be considered:
a.Your teaching certification
b.PDE Notice of Inactive Certification
c.Brief statement explaining your reason(s) for appeal
d.Any necessary documentation to support your appeal
The Bureau must receive all appeals within 30 days of the date of the PDE Notice of Inactive Certification.
10. Applicant Statement:
I certify that the information provided in this application, including all statements, transcripts and documentation, are correct and true. I understand that the falsification of any statement or document may result in the revocation of my Pennsylvania certificate.
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Print Name |
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Signature of Applicant |
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Date |
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PDE USE ONLY |
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Approved |
Denied |
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Initials |
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Pennsylvania Department of Education |
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PDE 338 |
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INSTRUCTIONS FOR APPEAL: ACT 48/ACT 45
In accordance with 1205.2(i) of the Public School Code (Act 48 of 1999)
FORM PDE 338
This form is used to file an appeal of the Department’s Notice of Inactive Certification for failure to meet Continuing Professional Development requirements. Mail an original and two copies of this completed form or a signed written request for appeal (including name, social security number, address, telephone number, statement of reason(s) for appeal, photocopy of denial letter, and other supporting documentation) to: Pennsylvania Department of Education, DPD Act 48/Act 45 Appeals, 333 Market Street – 3rd Floor, Harrisburg, PA,
PRINT IN CAPITAL LETTERS WITH DARK BLUE OR BLACK INK ONLY
1.Print your Last Name, First Name and Middle Initial.
2.Print your complete address, and enter your Zip Code.
3.Print your former name(s), if applicable, beginning with the most recent.
4.Enter your Social Security Number. Failure to provide SSN may result in a delay of appeal processing.
5.Enter your Date of Birth (Month, Day, Year).
6.Print M or F in the correct box for male or female.
7.Enter your telephone numbers (Home and Daytime) in case we need to contact you.
8.Select the reason for appeal.
9.Please submit the following documentation:
a.Request Form PDE 338
b.Copy of teaching certificate
c.Copy of PDE Notice of Inactive Certification
d.Brief statement explaining your reason(s) for your appeal, including the factual and legal basis for the appeal. You must state a reason for appeal in order for your appeal to be considered.
e.Other necessary documentation to support your appeal.
10.Applicant Statement. Your signature on this form or on your written request verifies that all of the information provided is correct and true. Misrepresentation/falsification of any statement or document may result in the revocation of your Pennsylvania certificate.
All appeals must be received by the Division of Professional Development within 30 days of date of Notice of Inactive Certification.
Mail the application and supporting documents to: Pennsylvania Department of Education, DPD Act 48/Act 45 Appeals, 333 Market Street – 3rd Floor, Harrisburg, PA,
NOTE: For credit discrepancies (credits/hours taken within the
1.View and print your continuing professional education records from PDE’s website (www.education.state.pa.us) to determine the specific discrepancy in credits/hours reported to the Department (see link to Reporting System on left navigation).
2.Contact the approved provider(s) concerning specific records where discrepancies exist.
If you have any questions, please check the PDE website at www.education.state.pa.us.