Instructions
Please enter your information and click "Submit" when you're done. All fields in blue are required.

Please record your account credentials for future reference after clicking the submit button.

Please make sure to complete all fields accurately. In particular, if you are licensed or applying for a license under certain PA Boards, you will need to enter additional information to ensure your record is sent to the PA Department of State, including your PA Board license number if applicable. Enter your full name exactly as it appears on your license, be sure to include your correct Date of Birth and SSN as well.

If you have any questions, please contact us at HelpCPSL@Pitt.edu.

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Title (Mr, Mrs, Dr, Prof, etc.):

First Name:

Middle Name:

Last Name:

Suffix (MD, DDS, PHD, MSW, etc.):

Primary Email Address (you must be able to access this email account to reset your password):

Confirm Primary Email Address:

Secondary Email Address:

Confirm Secondary Email Address:

County of Residence:

County of Employment:

Gender:

Race:

Ethnicity:

How did you hear about this course?:

Other

Are you currently licensed or will you be applying for a license within the next 6 months through one of the following Pennsylvania boards?

By selecting "No", I acknowledge my information will NOT be sent to the Department of State for initial licensure, license renewal, or license reinstatement.

SSN (Last 4 digits only):
Date of Birth:	/ /
Are you currently licensed in Pennsylvania?
Pennsylvania License number	Enter number exactly as it appears on your license, for example, RN012345L, no special characters or spaces (-,/,@,$,=, etc). Please do not enter an NPI number.
Confirm Pennsylvania License number

Are you an Educator seeking Act 126 and/or Act 48 credit?

Are you affiliated with a district that submits your Act 48 credits to the PA Dept of Education?

Professional Personnel ID (PPID):

The following questions are included to help us better understand what currently motivates individuals to file reports with Childline. This information will be collected anonymously for statewide data gathering purposes only and your answers will not be directly connected to your registration or lead to follow-up with you individually.

Have you ever made a report of child abuse or neglect before?

Have you ever made a report to Childline when you did not suspect child abuse or neglect?

Please select the reason(s) why you made a report to Childline when you did not suspect the child to be a victim of abuse or neglect. Select all that apply.

To protect myself and/or my organization from legal liability.
I did not know who else to call to connect the child and/or family to needed social service resources (for example, housing supports, food, or mental health services).
I was concerned that there would be future abuse or neglect without immediate intervention.
Other.

Please describe the reason you made a report to Childline when you did not suspect the child to be a victim of abuse or neglect

Recognizing and Reporting Child Abuse: Mandated and Permissive Reporting in Pennsylvania. New User Registration