OADLC Online Training Registration Form

Division of Licensing

Older Adult Daily Living Center (OADLC) Online Training

REGISTRATION FORM

All Older Adult Daily Living Center (OADLC) facilities are required to have a Director and a Designee who acts as Director during the primary Director’s absence. Both the Director and Designee must complete the OADLC Director Online Training Course via the Pennsylvania Department of Aging Learning Management System (PDA LMS) training portal.

The OADLC Director must complete and submit the form below to request online training access for themself or their designated Director.
- If you are a new OADLC applying for initial licensure, please print/download this completed form and submit it to the Pennsylvania Department of Aging along with your completed application (click here for details regarding Adult Day Center licensing in Pennsylvania).
- If you are an existing center that has a change in leadership, the center Director should complete/submit this form asap.
- Once PDA receives, reviews, and approves your form, a PDA LMS training account will be established for the Director and/or Designee, and login credentials will be sent to the email address provided to access the PDA LMS training portal and complete the OADLC Director Online Training Course. Upon successful completion of the training course, the LMS awards a certificate that the user must print/download and send to the Pennsylvania Department of Aging's Division of Licensing at RA-AIADULTLICENSING@pa.gov.
NOTE: The Older Adult Daily Living Center Online Training is also available to non-administrative center staff; however, completion of the training for non-administrative center staff is for training purposes only and does not qualify them as a center Director or Designee.
OADLC Facility Information:
Facility LEGAL Name:*
Facility D/B/A Name:*
If the facility does not operate under a D/B/A name, type N/A above.
Facility Street Address 1:*
Facility Street Address 2:
Facility City:*
Facility Zip Code:*
enter five (5) numbers only
Facility County:*
If the facility serves multiple counties, please select the county that houses the main/administrative office.
Facility Telephone Number:*
Must be a direct telephone number of the ADC Facility.
Facility Email Address:*
If the OADLC/facility does not have an assigned email address, type the Director's email address.
Facility Website:*
If the facility does not have a website, type N/A.

Contact Information of the Person Submitting this Form:

This form must be completed and submitted by the primary OADLC facility Director responsible for overseeing the daily operations of the center, and not a "designee" Director.
NAME OF "PRIMARY" FACILITY DIRECTOR APPROVING THIS REQUEST:

Director's First NameDirector's Last Name
EMAIL ADDRESS OF "PRIMARY" FACILITY DIRECTOR APPROVING THIS REQUEST:
example@example.com (DO NOT enter the facility's email address or DO NOT use an info@ or admin@ email address.

Select one of the two options below to qualify this request for access to the OADLC Online Training. This request is being submitted for an:*

OADLC Administrative Staff (Director [self], Assistant Director, Administrator, or Designee)OADLC Non-Administrative Staff

OADLC Director* Information:

*Must be a Director (self), Assistant Director, Administrator, or Designee!
The information you enter on this page, must be for the individual for whom you are requesting access to the OADLC Online Training course.
NAME:*

First NameLast Name
DATE OF HIRE:*

MonthDayYear
JOB TITLE:*
TELEPHONE NUMBER:*
Provide the best number for PDA to contact the indivdiual for additional information, if needed.
EMAIL ADDRESS:*
Must be a unique email address for the individual who needs OADLC training access. DO NOT enter the facility's email address or an info@ / admin@ email address.
NOTICE! DOCUMENTATION REQUIRED:

Pennsylvania Department of Aging (PDA) requires the submission of the following credentials before providing approval for Older Adult Daily Living Center 'administrative staff' to access and complete the OADLC Online Training:
1. Credentials (such as resume, degree, job application)
2. Criminal History Report
3. Prehire Physical Examination
4. Tuberculin Skin Test Result
Use the 'File Upload > Browse Files' section below to submit the required documentation.
File Upload:*

Click 'Browse Files' to locate & upload the required documentation/files.
Cancelof
OADLC Non-Administrative Staff Information:

This section must be completed by the OADLC/facility 'Director' ONLY on behalf of a non-administrative staff member! Non-Administrative staff may complete the OADLC Online Training for training purposes; however, their completion of the training does NOT qualify them as a Director or Designee.
Non-Administrative Staff Name:*

First NameLast Name
Non-Administrative Staff Date of Hire:*

MonthDayYear
Non-Administrative Staff Job Title:*
Non-Administrative Staff Telephone Number:*
Enter the designee's contact phone number (different than the Director's contact phone #)
Non-Administrative Staff Email Address:*
Must be the non-administrative staff member's unique email address. DO NOT enter the facility's email address, DO NOT enter the Director's email address, or DO NOT use an info@ or admin@ email address.
Should be Empty:

OADLC Facility Information:

OADLC Director* Information:

OADLC Non-Administrative Staff Information: