↣

Free Connecticut Ed 174 PDF Template

The Connecticut Ed 174 form is an application used to obtain a Substitute Teacher Authorization for individuals who have not completed a bachelor’s degree. This form collects personal information, educational background, and attestation from applicants, ensuring they meet the necessary requirements to serve as substitute teachers. For those interested in applying, fill out the form by clicking the button below.

Launch Editor Now

Navigation

The Connecticut Ed 174 form is a crucial document for individuals seeking authorization to work as substitute teachers in Connecticut without having completed a bachelor's degree. This form requires applicants to provide personal information, including their name, contact details, and social security number. In addition to basic identification, candidates must disclose their educational background, detailing all completed schooling and any relevant experience working with school-age children. The application also includes a section where applicants must attest to their honesty and accuracy in the information provided, emphasizing the importance of transparency in the application process. Furthermore, the form necessitates a criminal history check and a review of any past disciplinary actions related to professional credentials. To ensure a smooth application process, candidates must attach specific documents and submit the form to their employing agent, who will complete the necessary attestations before forwarding it to the Bureau of Educator Standards and Certification. Understanding the requirements and structure of the Ed 174 form is essential for prospective substitute teachers aiming to navigate the authorization process effectively.

▼ Connecticut Ed 174 PDF Form

Popular PDF Forms

Connecticut Probate Court - Failure to deliver a will to the court may result in criminal penalties.

For those looking to navigate the complexities of selling or purchasing a motorcycle, obtaining the appropriate documentation is vital. The Templates and Guide offers essential insights and resources, ensuring that both parties involved are well-informed and protected throughout the transaction process.

Apprenticeship Program - Encourage keeping abreast of any stipulations or conditions that may arise related to the training completion.

File Information

Fact Name	Details
Form Purpose	The ED 174 form is used to apply for a Substitute Teacher Authorization for candidates who have not completed a bachelor’s degree.
Governing Laws	This form is governed by Connecticut General Statutes (C.G.S.) 10-145, P.A. 11-27, and C.G.S. 10-145d.
Submission Address	Applications should be sent to the Bureau of Educator Standards and Certification, P.O. Box 150471 – Room 243, Hartford, CT 06115-0471.
Criminal Background Check	Applicants must undergo a criminal history records check as mandated by C.G.S. 10-221d.
Child Abuse Registry Check	Applicants are also required to submit to a check of the Department of Children and Families’ child abuse and neglect registry.
Application Validity	The Substitute Teacher Authorization expires on June 30 of the school year in which it was approved.
Signature Requirement	Original signatures are required on the application. No signature stamps will be accepted.

Connecticut Ed 174 Sample

	ED 174	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 1/12	Bureau of Educator Standards and Certiication
	C.G.S. 10-145, P.A. 11-27	P.O. Box 150471 – Room 243
	C.G.S. 10-145d	P.O. Box 150471 – Room 243
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-420	Hartford, CT 06115-0471
		www.ct.gov/sde

APPLICATION FOR SUBSTITUTE TEACHER AUTHORIZATION

FOR CANDIDATES WHO HAVE NOT COMPLETED A BACHELOR’S DEGREE

PART I: PERSONAL INFORMATION (Print all information in dark ink and in uppercase letters.)

LAST NAME

FIRST NAME

GENDER (M/F)

–

SOCIAL SECURITY NUMBER

BIRTH DATE (Month-Day-Year) – Required

ADDRESS (Street)

(Apt #)

(City)

–

FORMER LAST NAME(S)

(State)

(Zip Code)

PHONE

–

Race/Ethnicity

Native American

(Home/Cell)

Asian/Paciic Islander

E-MAIL ADDRESS

Black

(Optional)

White

Hispanic

Have you ever been convicted of any crime, excluding minor trafic violations?

YES

2. Have you ever been dismissed for cause from any position?

YES

Have you ever surrendered a professional certiicate, license, permit or other credential

YES

(including, but not limited to, an education credential); had one revoked, suspended,

annulled, invalidated, rejected or denied for cause; or been the subject of any other

adverse or disciplinary credential action?

Pursuant to Connecticut General Statutes Section 10-221d, the State Board of Education must complete a criminal history records check on each applicant for an initial issuance or renewal of a certiicate, authorization or permit. Each applicant seeking an initial issuance or renewal of a certiicate, authorization or permit must also submit to a records check of the Department of Children and Families’ child abuse and neglect registry established pursuant to Connecticut General Statutes Section 17a-101k. In addition, the State Board of Education is required to submit periodically for a criminal history records check the database of all persons who hold any certiicate, authorization or permit.

NOTE: If you answer “YES” to any of the above questions, you must attach a signed statement of explanation. If there are multiple incidents within each question, you must list and explain each separately. Submit oficial copies of court or adminis- trative record(s), including disposition of each case.

Information on this application is subject to disclosure pursuant to the Freedom of Information Act.

PAGE 1

ED 174

PART II: EDUCATIONAL BACKGROUND

List all education you have completed, including high school, trade-related vocational school and/or other postsecondary schooling.

NAME OF SCHOOL

STATE DATES ATTENDED

From (M/Y) To (M/Y)

EDUCATION LEVEL COMPLETED

(H.S. Diploma, GED, Assoc. Degree)

List ALL substitute teaching experience or any other experiences you have had working with school-age children, along with any unique qualiications for the substitute position. (Please attach your resume, or a separate sheet, if necessary.)

PART III: APPLICANT ATTESTATION

I certify that the information provided by me on this application and any accompanying documents contains no material misrepresentations, falsiications or omissions and that all of the information given by me is true, complete and accurate. I understand that all application and accompanying information may be veriied and that any material misrepresentation, falsiication or omission may result in the denial or revocation of my certiicate(s), permit(s) or authorization(s).

ORIGINAL SIGNATURE OF APPLICANT

DATE:

PART IV: EMPLOYING AGENT INFORMATION AND ATTESTATION

The applicant will serve only as a substitute teacher in random assignments and only up to 40 days in one assignment.

Signature of Superintendent, Executive Director or designee attesting to the accuracy of information

(Original Signature: No Signature Stamps Accepted)

Typed or Printed Name of Person Signing Above

District

Street

City,

State, Zip Code

FOR OFFICE USE ONLY

The person named on this application is authorized of education listed above.

Authorized Signature:

Date

Title

Telephone

FAX Number

E-mail Address

is NOT authorized to serve as a substitute teacher for the board

Date:

Original Signatures Must Be On Form Submitted

PAGE 2

ED 174	CONNECTICUT STATE DEPARTMENT OF EDUCATION
REV. 1/12	Bureau of Educator Standards and Certiication
REV. 1/12
C.G.S. 10-145, P.A. 11-27	P.O. Box 150471 – Room 243
C.G.S. 10-145d	P.O. Box 150471 – Room 243
Regs. 10-145d-420	Hartford, CT 06115-0471
	Hartford, CT 06115-0471
	www.ct.gov/sde

INSTRUCTIONS TO APPLICATION FOR SUBSTITUTE TEACHER AUTHORIZATION

FOR CANDIDATES WHO HAVE NOT COMPLETED A BACHELOR’S DEGREE

THIS CHECKLIST MUST BE ATTACHED TO THE COMPLETE APPLICATION PACKET

Listed below are the required documents which must be submitted to the Bureau of Educator Standards and Certi- ication to process your request for a Substitute Teacher Authorization for candidates who have NOT completed a bachelor’s degree. This authorization will expire on June 30 of the school year during which it was approved.

Applicant:

a. Complete Parts I, II and III.

b. Return completed application to the superintendent of schools, executive director or designee.

Employing Agent:

a. Complete Part IV and mail application and supporting documentation to the Bureau of Educator Standards and Certiication at the above address.

Information on this application is subject to disclosure pursuant to the Freedom of Information Act.

Common mistakes

Filling out the Connecticut Ed 174 form can be a straightforward process, but many applicants make common mistakes that can delay their application. One of the most frequent errors is failing to use dark ink and uppercase letters as instructed. This might seem minor, but forms filled out in light ink or lowercase can be difficult to read, leading to potential processing delays.

Another mistake involves incomplete personal information. Applicants sometimes forget to fill in all required fields, such as their social security number or birth date. Omitting this information can result in an immediate rejection of the application. It’s crucial to double-check that every section is fully completed before submission.

Many people also overlook the importance of providing a valid email address. This contact detail is essential for communication regarding the application status. A missing or incorrect email could mean missing out on important updates or requests for additional information.

When it comes to the criminal history questions, applicants often answer “no” without fully considering their past. If someone has a conviction or disciplinary action that they believe is minor, they might mistakenly think it doesn’t need to be disclosed. However, the form clearly states that any “yes” answers require a signed statement of explanation. Ignoring this can lead to serious consequences.

In the educational background section, applicants frequently fail to list all relevant schooling. It’s important to include every institution attended, along with the dates and levels of education completed. Missing this information can lead to questions about qualifications and may delay the approval process.

Another common oversight is neglecting to attach a resume or additional documentation that outlines substitute teaching experience. While the form asks for this information, some applicants forget or assume it’s unnecessary. Providing a resume can significantly strengthen an application and clarify relevant experience.

Some applicants may also rush through the attestation section, failing to understand its importance. This section requires a signature that confirms the accuracy of the provided information. Skipping this step or using a signature stamp instead of an original signature can lead to automatic rejection.

Finally, applicants sometimes forget to check the checklist of required documents before submitting their application. This checklist is vital for ensuring that all necessary paperwork is included. Missing documents can result in delays or a return of the application, requiring additional time and effort to resubmit.

Key takeaways

Filling out the Connecticut Ed 174 form is a crucial step for individuals seeking authorization to serve as substitute teachers without having completed a bachelor's degree. Here are some key takeaways to keep in mind:

Accurate Information is Essential: Ensure that all personal details, including your name, social security number, and contact information, are filled out accurately. Any discrepancies could delay the processing of your application.
Criminal History Disclosure: Be prepared to answer questions regarding any past convictions or professional dismissals. If you answer "yes" to any of these questions, a signed explanation must accompany your application, detailing each incident.
Educational Background Matters: List all educational experiences, from high school to any vocational training. This includes the names of schools attended and the dates of attendance. Your educational background plays a significant role in your application.
Experience with Children: Document any substitute teaching experience or work with school-age children. This information is vital in demonstrating your qualifications for the position. Attach a resume or an additional sheet if necessary.
Signature Requirements: The application requires original signatures from both the applicant and the employing agent. Make sure that no signature stamps are used, as this will invalidate the application.

Understanding these key points will help streamline the process and increase the likelihood of a successful application for substitute teacher authorization in Connecticut.

Similar forms

The Connecticut Ed 174 form is similar to the Teacher Certification Application, which is used by educators seeking to obtain a full teaching certificate. Both documents require personal information, educational background, and attestations regarding the applicant's qualifications. However, the Teacher Certification Application typically demands a higher level of education, usually a bachelor's degree, and includes additional documentation such as proof of student teaching experience. Both forms serve as essential tools for ensuring that individuals entering the teaching profession meet state standards for education and conduct.

When preparing for legal agreements, it's essential to understand the implications of a Hold Harmless Agreement, which can protect parties involved during various transactions. For further details, refer to this informative guide on Hold Harmless Agreement forms.

Another document akin to the Ed 174 is the Emergency Substitute Teacher Permit Application. This permit is designed for individuals who may not have completed a full certification process but are needed to fill in for teachers on short notice. Similar to the Ed 174, this application requires personal information and a background check. However, the Emergency Substitute Teacher Permit may have different requirements regarding prior teaching experience and the length of time the permit is valid, reflecting the urgency and temporary nature of its intended use.

The Background Check Authorization Form is also comparable, as it is a necessary component of many educational applications, including the Ed 174. This document specifically focuses on obtaining consent for a criminal history check, which is a crucial step in ensuring the safety of students. While the Ed 174 includes a section on criminal history, the Background Check Authorization Form is a standalone document that emphasizes the importance of safeguarding children in educational environments.

Similarly, the Child Abuse Registry Check Form is relevant, as it is often required for educators and those working with children. Like the Ed 174, this form ensures that applicants are screened for any history of child abuse or neglect. Both documents aim to protect children by ensuring that individuals who pose a risk are not placed in educational settings, although the Child Abuse Registry Check Form is specifically focused on this aspect of background verification.

The Employment History Verification Form shares similarities with the Ed 174 in that it requires applicants to detail their previous employment, particularly in educational settings. Both forms aim to provide a comprehensive overview of an applicant's qualifications and experiences. However, the Employment History Verification Form typically requires verification from previous employers, while the Ed 174 focuses more on the applicant's self-reported experiences and qualifications.

The Professional Reference Form is another document that is often associated with educational applications, including the Ed 174. This form collects feedback from individuals who can attest to the applicant's qualifications and character. While the Ed 174 includes an attestation section, the Professional Reference Form specifically seeks external validation from past colleagues or supervisors, providing a more rounded view of the applicant's capabilities.

Lastly, the Student Teaching Experience Verification Form is comparable to the Ed 174 in that it documents practical teaching experience. While the Ed 174 is aimed at those who have not yet completed a bachelor's degree, the Student Teaching Experience Verification Form is typically used by those who are in the process of completing their educational requirements. Both forms emphasize the importance of hands-on experience in the field of education, highlighting the need for practical application of teaching theories and methodologies.