Mansfield University of Pennsylvania

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Mansfield University Home Page > Teacher Education & Educational Field Experiences Home Page > Renewal Clearance Instructions

To Renew for Student Teaching


For Student Teaching:

Visit the campus clinic (#4350 for an appointment) for a TB Tine test. The Clinic will provide a portion of a three part form for you, and another for you to provide to the Field Experience Office - RC 205. 


Visit your personal physician for a TB Tine test. Have your physician provide a prescription sheet, or office letter head including the following:

Patient name, social security number, and date of birth
Office name and location
Results (negative/positive) of TB Tine/Mantoux test
Doctor’s signature


FAST!! On-line ACT 34 Criminal Record Check request: Pennsylvania Access to Criminal History (on-line with credit card) Print two!! Take copy to the Field Experience Office - 205 Retan Center


SLOW!! Print out and snail mail ACT 34 Criminal Record Check request: Act 34 Clearance.pdf (print)

Fill out your name, address, and telephone number. Do not use the address of the potential employer or Department of Education. Submit a $10.00 money order payable to Commonwealth of Pennsylvania. Mail in and wait approximately four weeks for it to return. Take original with copy to the Field Experiences Office - RC 205



  1. Print clearly and neatly in ink or type section I only.
  2. Address must be applicant's current home address.
  3. All information must be completed in full.
  4. Clearance must be signed.
  5. $10 Money order must be enclosed payable to Department of Public Welfare.
  6. One block must be checked. **
  7. Send no postage paid return envelopes of any kind.

The form specifically asks for all previous names, addresses and household members since 1975. This information must be provided to the best of your knowledge and belief.  Attach additional pages, if necessary.

** Check the school employment block for college courses or student teaching.

Mail in and wait approximately two weeks for it to return.
Take original with copy to the Field Experiences Office - RC 205

Pennsylvania ACT 114 Fingerprinting

  1. Cogent Fingerprinting Services - PA Department of Education
  2. Registration - Register On-line
  3. Dissemination Disclaimer check box and press continue
  4. Complete Applicant Registration
  5. Call fingerprint site you plan to visit and make appointment
  6. Have fingerprints scanned. Wait for clearance to return in mail.
  7. Bring the original and a copy to Field Experiences - RC 205

Updated 1/18/11 FBI Fingerprint Site in Wellsboro
There is a FBI scan site in Wellsboro at the Tioga County Courthouse.
By Appointment ONLY!  M-F 9:00 - 12:00 & 1:00 - 3:00  
Pre-register and pay fee on the cogentid site then call Penny Whipple for
an appointment 570-723-8231.

Links with helpful information regarding the Pennsylvania ACT 114 Fingerprinting effective 4/1/07:

ACT 114 FBI Clearance Q&A

ACT 114 FBI Clearance Public Communication 3-13-07

Please note: Students seeking employment in states other than Pennsylvania will want to check individual state clearance requirements to be prepared for job searching after student teaching. (Ex: New York State requires the OSPRA clearance. )


Pennsylvania Arrest/Conviction Report and Certification Form Print, read, sign and take to the Field Experience Office - RC 205


(Choose any of the following five options)

A note regarding professional liability insurance: Students shall be responsible for procuring professional liability insurance at their own expense. The limits of the policy shall be a minimum of $1,000,000.00 per claim and an aggregate of $3,000,000.00 per occurrence. This policy must remain in full force and effect for the duration of the practicum, field experience, or student teaching assignment.

Take your original documents along with copies to the Field Experience Office, Retan Center, Room 205, prior to established deadlines!!

Application for Pennsylvania Certification

Monitor your mounties email account for application information from Certification Officer, Lori Cass.

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