Request for Completion of Approved Continuing Teacher and Leader Education (CTLE) Hour(s) Certificate from Professional Development Institute (PDI) Sponsor # 23352
**Please note that the certificate will only be issued after a final grade for your course has been issued. You must complete all course requirements and receive a final grade before submitting a request for this certificate. Certificates will only be issued to those NYSED participants who have successfully completed all course requirements upon receiving their final course grade. The certificate will be emailed to the participant once completed and signed by PDI's Certifying Officer.

Please note that a SEPARATE form must be submitted for EACH course completed.

The following information is required by NYSED sponsors in order to issue a CTLE Certificate.


Email address *
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
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YYYY
Last 4 Digits of Social Security Number *
Your answer
Completed PDI Course Title/Course Number *
Please note that a SEPARATE form must be submitted for EACH course completed.
Your answer
Final Course Grade *
A copy of your responses will be emailed to the address you provided.
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