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Free Connecticut Ed 177 PDF Template

The Connecticut Ed 177 form is an application for the Durational Shortage Area Permit (DSAP), which allows schools to fill positions that cannot be occupied by certified candidates. This form must be submitted by school or district officials and cannot be initiated by the applicant. To ensure compliance and a smooth application process, it is crucial to follow the outlined instructions carefully.

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The Connecticut Ed 177 form is a crucial document for educators seeking a Durational Shortage Area Permit (DSAP). This permit is essential when a school or district cannot find a qualified candidate to fill a teaching position. The application process for the DSAP is initiated by the employing school or district, not by the applicant themselves. It is important to submit the Ed 177 form before the candidate's first day of employment. The form requires candidates to complete specific sections, including providing official transcripts that demonstrate their qualifications in the relevant subject area. Additionally, school or district officials must complete their designated sections and submit supporting documentation to the Bureau of Educator Standards and Certification. This ensures that all eligibility criteria are met. The application also includes an "Evidence of Enrollment" attachment, which may be necessary depending on the candidate's educational background. For those seeking reissuance of the DSAP, the process involves similar requirements, including proof of continued education in the subject area. Understanding these components is vital for both candidates and school administrators to navigate the certification process effectively.

▼ Connecticut Ed 177 PDF Form

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File Information

Fact Name	Details
Form Purpose	The ED 177 form is used to apply for the Durational Shortage Area Permit (DSAP) in Connecticut.
Governing Laws	The form is governed by Connecticut General Statutes (C.G.S.) 10-145 and 10-145d, as well as Regulations 10-145d-421 and 10-145d-422.
Application Submission	Only school or district officials may submit the ED 177 form; applicants cannot initiate their own applications.
Transcript Requirements	Applicants must attach official transcripts showing completion of at least 12 semester hours in the relevant subject area.
Effective Date	The effective date of the DSAP may be the date the ED 177 is received, provided all requirements are met beforehand.

Connecticut Ed 177 Sample

		INSTRUCTIONS – PAGE 1
	ED 177	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 9/20	Bureau of Educator Standards and Certification
	C.G.S. 10-145	P.O. Box 150471
	C.G.S. 10-145d	P.O. Box 150471
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422
		www.ct.gov/sde/cert
		INSTRUCTIONS FOR FORM ED 177

APPLICATION FOR FIRST ISSUANCE OF THE DURATIONAL SHORTAGE AREA PERMIT (DSAP)

A Durational Shortage Area Permit (DSAP) may be requested by the school or district if a position cannot be filled by an appropriately certified candidate. An application for issuance of a DSAP cannot be initiated by the applicant. The effective date of the DSAP may be the date the original ED 177 is received, provided all requirements for issuance have been met on or before this date. An

ED 177 must be submitted prior to the first day of employment.

Please complete the appropriate section of the checklist below.

CANDIDATE

a. Complete Parts I, II, and III of the application form (ED 177).

b. Attach official transcripts showing the completion of at least 12 semester hours of credit in the subject for which the DSAP is requested. An official transcript showing the completion of a bachelor’s degree must be included if the candidate has never held certification in Connecticut.

SCHOOL OR DISTRICT OFFICIAL

The application form (ED 177) and supporting documentation must be submitted by the employing agent to the Bureau of Educator Standards and Certification. The “Evidence of Enrollment” form ED 177 (Attachment) may be submitted separately.

a. Complete Parts IV and V of the application form (ED 177).

b. Complete the “Evidence of Enrollment” form ED 177 (Attachment) – Part A, if applicable. If this part is required, return the

Attachment to the candidate for signature by the appropriate higher education official where the candidate is enrolling in a teacher preparation program or the Alternate Route to Certification program. The Attachment need not be completed if the candidate holds a valid Connecticut certificate and is completing course work under a DSAP to fulfill requirements for a cross endorsement (except for endorsements 102, 112 or 113), or if the candidate has at least 20 school months of successful appropriate* teaching experience in an approved nonpublic school.

EDUCATOR PREPARATION PROVIDER

a. Complete the “Evidence of Enrollment” form ED 177 (Attachment) – Part B and Part C, if applicable. The Attachment need not be completed if the candidate holds a valid Connecticut educator certificate and is completing course work under a DSAP to fulfill requirements for a cross endorsement (except for endorsements 102, 112 or 113), or if the candidate has at least 20 school months of successful appropriate* teaching experience in the same approved nonpublic school.

*The twenty months must be in the subject area or field for which the initial educator certificate will be sought (CT State Regulation 10-145d-412 (3)(A)).

		INSTRUCTIONS – PAGE 2
	ED 177	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 9/20	Bureau of Educator Standards and Certification
	C.G.S. 10-145	P.O. Box 150471
	C.G.S. 10-145d	P.O. Box 150471
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422
		www.ct.gov/sde/cert

APPLICATION FOR REISSUANCE OF THE DURATIONAL SHORTAGE AREA PERMIT (DSAP)

A Durational Shortage Area Permit (DSAP) may be requested by the employing agent of a board of education if a position cannot be filled by an appropriately certified candidate. An application for issuance of a DSAP cannot be initiated by the applicant. The effective date of the DSAP will be the date the original ED 177 is received, provided all requirements for issuance have been met on or before this date. An ED 177 must be submitted prior to the first day of employment.

The following checklist outlines the sections of the form to be completed and documents which must be submitted by the employing agent in order for the Bureau of Educator Standards and Certification to determine eligibility for a DSAP.

CANDIDATE

a. Complete Parts I, II, and III of the application form (ED 177).

b. Attach official transcripts showing the completion of at least nine semester hours of credit during the validity period of the previous DSAP in the subject for which the DSAP is requested.

SCHOOL OR DISTRICT OFFICIAL

The application form (ED 177) and supporting documentation must be submitted by the employing agent to the Bureau of Educator Standards and Certification. The Attachment may be submitted separately.

a. Complete Parts VI and VII of the application form (ED 177).

b. Complete the “Evidence of Enrollment” form ED 177 (Attachment) – Part A, if applicable. If this part is required, return the

EDUCATOR PREPARATION PROVIDER

*The twenty months must be in the subject area or field for which the initial educator certificate will be sought (CT State Regulation 10-145d-412 (3)(A)).

INSTRUCTIONS – PAGE 3

ED 177

CONNECTICUT ENDORSEMENT CODES

Teaching Endorsements

010Business, 7–12

015English, 7–12

018French, 7–12

019German, 7–12

020Italian, 7–12

021Latin, 7–12

022Russian, 7–12

023Spanish, 7–12

024Other World Language, 7–12

026History & Social Studies, 7–12

029Mathematics, 7–12

030Biology, 7–12

031Chemistry, 7–12

032Physics, 7–12

033Earth Science, 7–12

034General Science, 7–12

035Driver Education

040Agriculture, Pre-K–12

041Vocational Agriculture, 7–12

042Art, PK–12

043Health, P –12

044Physical Education, PK–12

045Home Economics, PK–12

047Technology Education, PK–12

049Music, PK–12

055Partially Sighted, PK–12

057Deaf and Hard of Hearing, PK–12

059Blind, PK–12

062School Library Media Specialist

072 School Nurse-Teacher

073School Dental Hygienist-Teacher

089Marketing Education, 7–12

101World Language Instructor, Elementary

102Remedial Reading & Remedial Language Arts, 1–12

104Cooperative Work Education/Diversified Occupations

110Unique Subject Area

111Teaching English to Speakers of Other Languages (TESOL), PK–12

112Integrated Early Childhood/Special Ed., Birth – Kindergarten

113Integrated Early Childhood/Special Ed., Nursery -K–Elem. 1–3

165Comprehensive Special Education, K–12

215English, Middle School

226History & Social Studies, Middle School

229Mathematics, Middle School

230Biology, Middle School

231Chemistry, Middle School

232Physics, Middle School

233Earth Science, Middle School

234General Science, Middle School

235Integrated Science, Middle School

305Elementary, 1 – 6

317Portuguese, 7–12

318Mandarin Chinese, 7–12

483Dance, Pre-K–12

485Theatre and Drama, Pre-K–12

511Montesori, Elementary, 1–6

512Montesori, Primary, Birth to Kindergarten

826Vocational Department Head: Trade Technology

Administrative Endorsements		Adult Education Endorsements
		Adult Education Endorsements
085	School Business Administrator	088	Non-English Speaking Adults
092	Intermediate Administration or Supervision	106	High School Credit Diploma Program
093	Superintendent of Schools	107	External Diploma Program/Noncredit Mandated Programs
097	Reading and Language Arts Consultant
105	Department Chairperson

Special Services Endorsements
061	Speech and Language Pathologist	Vocational Endorsements
068	School Counselor	082	Vocational Technical Administrator
070	School Psychologist	090	Occupational Subject, Vocational Technical Schools
071	School Social Worker	091	Trade-Related Subjects, Vocational Technical Schools
268	School Marriage and Family Therapist	098	Trade & Industrial Occupations – Comprehensive High School
		103	Health Occupations – Comprehensive High School
		108	Practical Nurse Education Instruction

NOTE: Bilingual codes are not provided. Check appropriate box on application to request a bilingual endorsement.

PAGE 4

	ED 177	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 9/20	Bureau of Educator Standards and Certification
	C.G.S. 10-145	P.O. Box 150471
	C.G.S. 10-145d	P.O. Box 150471
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	www.ct.gov/sde/cert
		www.ct.gov/sde/cert

APPLICATION FOR DURATIONAL SHORTAGE AREA PERMIT (DSAP)

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

LAST NAME

FIRST NAME

˗ ˗

SOCIAL SECURITY NUMBER

ADDRESS (Street ONLY, no P.O. Box)

CITY

ZIP CODE

MIGENDER ˗ ˗

BIRTH DATE (Month-Day-Year) - Required

APT. #

(State)

FORMER LAST NAME(S)

PHONE

(Home/Cell)

Race/Ethnicity

(Work)

(Optional)

E-MAIL ADDRESS

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

YES

Have you been dismissed for cause from any position?

YES

Have you ever surrendered a professional certificate, 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?

1.Native American

2.Asian/Pacific Islander

3.Black

4.White

5.Hispanic

Pursuant to Connecticut General Statutes Section 10-221d, the State Board of Education must submit, periodically, a database of applicants for an initial issuance of a certificate, authorization or permit to the State Police Bureau of Investigation for a criminal history record check. Each applicant seeking an initial issuance or renewal of a certificate, 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 criminal history records check the database of all persons who hold any certificate, 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 official copies of court or administrative record(s), including disposition of each case.

Original Signatures Must Be On The Form Submitted

PAGE 1

ED 177

PART II: EDUCATIONAL BACKGROUND

List the names of the colleges or universities attended:

		Dates Attended	Major Field	Degree
Name of Institution	State/Country	From To	of Study	Awarded

PART III: CANDIDATE ATTESTATION

I certify that the information provided by me on this application and any accompanying documents contains no material misrepresentations, falsifications 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 verified and that any material misrepresentation, falsification or omission may result in the denial or revocation of my certificate(s), permit(s) or authorization(s).

By checking the “I Agree” box, you agree your typed signature is the legal equivalent of your manual signature on this application.

I Agree

SIGNATURE OF CANDIDATE:

DATE:

PART IV:

SCHOOL OR DISTRICT REQUEST FOR FIRST ISSUANCE OF THE DSAP

1.No certified candidate suitable for the position is available to serve in the subject(s) requested. I hereby request issuance of a DSAP for the applicant to serve as:

		Endorsement Required for Position
Specific Subject or Field to be Taught
	Grade Level

(see endorsement code list)

Check box if bilingual endorsement is sought in above subject.

Indicate language of the bilingual endorsement

2.List the steps that have been taken to secure a suitable certified person, including dates and specific locations of newspaper, media, vacancy notices, university postings, Internet job positions, teacher agency listings, etc. Please note that advertisements must be within 6 months.

a. Total number of candidates who applied for this position:

b. Number of candidates who hold appropriate Connecticut certification:

c. Number of candidates interviewed for this position:

d.Reason(s) why certified candidates, if any, were not hired. Include any circumstances and conditions which make this position difficult to fill:

3.Indicate why a DSAP is requested for this particular uncertified applicant.

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

PAGE 2

ED 177

PART V: ATTESTATION AND SIGNATURE OF EMPLOYING AGENT

The candidate named on this application:

Has been or will be entered into the Connecticut State Department of Education (CSDE) electronic staff file Educator Data System (EDS), with an assignment code appropriate to the endorsement sought under the DSAP.

Will be given special attention in the form of supervision and other assistance, as appropriate.

Signature of Superintendent, Executive Director or Designee
		Date
attesting to accuracy of information
(Original Signature: No Signature Stamps Accepted)
Typed or Printed Name of Person Signing Above
		Title
School or District		Telephone
City	State Zip Code
		E-mail Address – School or District Contact
		Person

Fax

PAGE 3

ED 177

PART VI:

SCHOOL OR DISTRICT REQUEST FOR REISSUANCE OF THE DSAP

1. I hereby request reissuance of a DSAP for the applicant to serve as:

Specific Subject or Field to be Taught Grade Level Endorsement Required for Position

(see endorsement code list)

Check box if bilingual endorsement is sought in above subject.

Indicate language of the bilingual endorsement

PART VII: ATTESTATION AND SIGNATURE OF SCHOOL OR DISTRICT

The candidate named on this application:

Has completed a minimum of nine semester hours of credit in the subject or field requested during the validity period of the previous DSAP.

Has or will be entered into the CSDE Educator Data System (EDS), with an assignment code appropriate to the endorsement sought under the DSAP.

Has successfully served under the previously issued DSAP.

Will be given special attention in the form of supervision and other assistance, as appropriate.

An ED 177 Attachment is being submitted, if enrollment in a program is required for the endorsement.

Signature of Superintendent, Executive Director or Designee		Date
attesting to accuracy of information
(Original Signature: No Signature Stamps Accepted)
Typed or Printed Name of Person Signing Above
			Title
School or District		Telephone
City	State Zip Code
		E-mail Address – School or District Contact
			Person

Fax

PAGE 4

ED 177 – Attachment

REV. 9/20

CONNECTICUT STATE DEPARTMENT OF EDUCATION

Bureau of Educator Standards and Certification

P.O. Box 150471

Hartford, CT 06115-0471

www.ct.gov/sde/cert

EVIDENCE OF ENROLLMENT IN AN APPROVED EDUCATOR PREPARATION PROGRAM

NOTE: This ED 177 Attachment need not be completed if the candidate holds a valid Connecticut teaching certificate and is completing course work toward a cross endorsement (except for endorsements 102, 112, or 113).

PART A: Verification of Employment (this part must be completed by the employing agent)

Candidate’s Last Name	First Name		MI		Social Security Number
Position/Subject or Field
Position/Subject or Field		Grade Level		Endorsement Required for Position

(see endorsement code list)

Check box if bilingual endorsement is sought in above subject.

Indicate language for the bilingual endorsement

The candidate named above is being considered for a position which requires the completion of course work under a Durational Shortage Area Permit (DSAP).

Signature of Superintendent, Executive Director or Designee			Date
(Original Signature: No Signature Stamp Accepted)
Typed or Printed Name of Person Signing Above			Title
School or District			Telephone
City	State	Zip Code	E-mail Address – School or Disrict Contact Person

PAGE 5

ED 177 – Attachment (continued)

Name of Applicant:

PART B: Evidence of Enrollment or Application to an Approved Planned Educator Preparation Program

Evidence of Enrollment for Admission to an Approved Planned Educator Preparation Program

The above-named candidate is currently enrolled in or has applied and been accepted for admission to a approved planned program leading toward the institution’s recommendation for certification in:

Position/Subject or Field

Grade Level

Date of Enrollment or Date of Acceptance into the Program

Total number of semester hours of credit required to complete this certification program:

Number of semester hours of credit the candidate has already completed:

PART C: Attestation and Signature of the Certification Officer or the Academic Director of the Alternate Route to Certification (ARC) Program

Signature of Certification Officer or			Date
Academic Director of the ARC Program
Typed or Printed Name of Person Signing Above
				Title
Educator Preparation Provider (College, University, ARC)			Telephone
City	State	Zip Code
			E-mail Address

Mail Completed Form To:

CONNECTICUT STATE DEPARTMENT OF EDUCATION

Bureau of Educator Standards and Certification

P.O. Box 150471

Hartford, CT 06115-0471

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

PAGE 6

Common mistakes

When completing the Connecticut Ed 177 form, individuals often make several common mistakes that can lead to delays or rejections of their applications. One frequent error is failing to complete all required parts of the form. Candidates must ensure that Parts I, II, and III are fully filled out. Incomplete sections can result in processing issues.

Another mistake is neglecting to attach official transcripts. The form requires candidates to provide transcripts showing the completion of at least 12 semester hours of credit in the relevant subject area. Omitting this documentation can hinder the approval process.

Some applicants do not print their information in blue ink and uppercase letters, as specified in the instructions. This oversight may lead to difficulties in reading the submitted information, potentially causing delays.

Additionally, applicants sometimes forget to provide their Social Security number. This information is necessary for identification purposes, and its absence can stall the application.

Misunderstanding the requirements for the "Evidence of Enrollment" form is another common issue. Candidates may fail to complete this form when required, which can complicate their application status.

In some cases, individuals mistakenly answer "YES" to questions about criminal history or professional credential issues without providing the necessary explanations. Each "YES" answer requires a signed statement detailing the circumstances, and failure to include this can result in automatic disqualification.

Applicants might also overlook the need for an original signature on the form. Submitting a form without a signature will render it invalid, leading to further delays.

Another error involves not submitting the application before the first day of employment. The Ed 177 must be received by the Bureau of Educator Standards and Certification prior to this date to ensure eligibility.

Some individuals may also misinterpret the endorsement codes, leading to incorrect selections on the application. It is crucial to verify that the correct endorsement code is chosen based on the subject area or field.

Lastly, candidates may not double-check their contact information, such as phone numbers and email addresses. Providing incorrect contact details can lead to communication issues, affecting the overall application process.

Key takeaways

The Connecticut Ed 177 form is essential for obtaining a Durational Shortage Area Permit (DSAP), which allows schools to hire candidates when certified applicants are unavailable.
Only the school or district can initiate the application process; candidates cannot apply directly for the DSAP.
All parts of the form must be completed accurately, including Parts I, II, and III by the candidate and Parts IV and V by the school or district official.
Official transcripts showing at least 12 semester hours of relevant coursework are required for first-time applicants. This ensures candidates have foundational knowledge in the subject area.
The effective date of the DSAP is determined by when the completed Ed 177 form is received, as long as all requirements are met prior to the first day of employment.
For reissuance of the DSAP, candidates must show they have completed at least nine semester hours of credit during the previous permit's validity period.

Similar forms

The Connecticut Ed 177 form shares similarities with the Application for Initial Certification (Form ED 166). Both documents are essential for individuals seeking to enter the teaching profession in Connecticut. They require the applicant to provide personal information, educational background, and any relevant certifications. The ED 166 focuses on initial certification, while the Ed 177 specifically addresses situations where a school cannot find a qualified candidate, allowing for a temporary permit. This distinction highlights the urgency and flexibility in filling teaching positions that are in short supply.

Another document akin to the Ed 177 is the Application for Certification Renewal (Form ED 167). This form is necessary for educators looking to renew their teaching credentials. Like the Ed 177, it requires supporting documentation, including proof of professional development and teaching experience. However, the ED 167 is aimed at those who have already been certified and are seeking to maintain their credentials, whereas the Ed 177 is for those entering the field under special circumstances.

The Application for Cross Endorsement (Form ED 168) is also similar to the Ed 177. This form allows certified teachers to expand their qualifications by adding additional endorsements to their existing certification. Both forms require the submission of educational transcripts and proof of relevant coursework. The key difference lies in the Ed 177's focus on filling positions in shortage areas, while the ED 168 is about broadening an educator's expertise and teaching scope.

To further assist you in the process, you may want to explore this easy Washington bill of sale form option that simplifies the sale and transfer of personal assets, ensuring that all terms are clearly outlined and understood.

The Emergency Certification Application (Form ED 169) is another related document. This form is used when a school district needs to fill a teaching position quickly and cannot find a fully qualified candidate. Similar to the Ed 177, it allows for a temporary solution to staffing shortages. However, the emergency certification often has more stringent requirements and is typically issued for a shorter duration than the permits granted through the Ed 177.

The Application for Temporary Authorization (Form ED 170) also bears resemblance to the Ed 177. This document is designed for individuals who are in the process of completing certification requirements but need to begin teaching immediately. Both forms provide a pathway for educators to start working while they fulfill the necessary qualifications. The main difference is that the ED 170 is more focused on those in transition, while the Ed 177 is specifically for filling urgent vacancies.

The Application for a Provisional Certificate (Form ED 171) is similar in that it provides a temporary certification option. This form allows individuals who have met certain educational criteria but lack full certification to teach. Like the Ed 177, it is a response to specific staffing needs within schools. However, the provisional certificate is often intended for educators who are closer to meeting full certification requirements compared to those applying for a DSAP.

Lastly, the Application for a Substitute Teacher Permit (Form ED 172) has parallels with the Ed 177. Both documents facilitate entry into teaching roles under specific conditions. The substitute permit allows individuals to teach on a temporary basis, while the Ed 177 permits educators to fill positions in shortage areas. The key distinction is that the substitute permit is more flexible and does not require the same level of educational background as the Ed 177.