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The Connecticut Ed 185 form is a crucial document for individuals seeking to obtain or renew a five-year renewable coaching permit. This form serves multiple purposes, including the collection of personal information, verification of qualifications, and compliance with state regulations. Applicants must provide their name, contact details, and social security number, along with answering questions regarding any past legal issues or professional conduct. Additionally, the form requires proof of completion of essential training courses, such as First Aid, CPR, and concussion awareness. It also mandates the submission of educational credentials, including high school diplomas or transcripts. For those applying for renewal, documentation of continued professional development through seminars or workshops is necessary. Each section of the form must be completed accurately to ensure a smooth application process, as any discrepancies can lead to delays or denials. Understanding the requirements and carefully preparing the necessary documentation can significantly ease the journey toward securing a coaching permit in Connecticut.
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File Information
| Fact Name | Description |
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| Governing Laws | The ED 185 form is governed by several Connecticut General Statutes, including C.G.S. 10-145, C.G.S. 10-145d, C.G.S. 10-149, and C.G.S. 10-149b. |
| Application Purpose | This form serves as an application for a Five-Year Renewable Coaching Permit in Connecticut, allowing individuals to coach in educational settings. |
| Personal Information Requirement | Applicants must provide personal details, including their name, social security number, address, and gender, all written in blue ink and uppercase letters. |
| Criminal History Check | As mandated by C.G.S. 10-221d, a criminal history records check is required for all applicants seeking initial issuance or renewal of the permit. |
| Training Requirements | Applicants must complete training courses in First Aid, CPR, and concussion awareness, with specific documentation required for each. |
| Disclosure of Information | Information provided on the application is subject to disclosure under the Freedom of Information Act, ensuring transparency in the application process. |
Connecticut Ed 185 Sample
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ED 185 |
CONNECTICUT STATE DEPARTMENT OF EDUCATION |
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REV. 1/12 |
Bureau of Educator Standards and Certiication |
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C.G.S.
P.O. Box 150471 – Room 243
C.G.S.
Hartford, CT
Regs. |
www.ct.gov/sde |
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APPLICATION FOR
PART I: PERSONAL INFORMATION (Print all information in blue ink and in uppercase letters.)
LAST NAME
FIRST NAME
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SOCIAL SECURITY NUMBER
ADDRESS (Street)
(City)
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GENDER (M/F) |
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BIRTH DATE
(Apt #)
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FORMER LAST NAME(S) |
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(State) |
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(Zip Code) |
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PHONE |
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Race/Ethnicity |
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Native American |
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(Home/Cell) |
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Asian/Paciic Islander |
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3. |
Black |
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(Optional) |
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White |
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5. |
Hispanic |
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1. |
Have you ever been convicted of any crime, excluding minor trafic violations? |
YES |
NO |
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2. |
Have you ever been dismissed for cause from any position? |
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YES |
NO |
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3. |
Have you ever surrendered a professional certiicate, license, permit or other credential |
YES |
NO |
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(including, but not limited to, an education credential); had one revoked, suspended, |
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annulled, invalidated, rejected or denied for cause; or been the subject of any other |
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adverse or disciplinary credential action? |
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Pursuant to Connecticut General Statutes Section
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 185
PART II: COMPLETION OF REQUIRED FIRST AID COURSE
The irst aid course must have been completed within 3 years prior to the date of application. Please sign your irst aid card and attach: (1) a photocopy of both the front and back of the irst aid card, or (2) original certiicate of completion, to this application.
Name of course completed |
Date of completion |
PART III: COMPLETION OF REQUIRED CPR COURSE
Please sign your valid CPR card and attach: (1) a photocopy of both the front and back of the CPR card, or (2) original certiicate of completion, to this application.
Name of course completed |
Date of completion |
PART IV: HIGH SCHOOL INFORMATION
Please attach a copy of your high school diploma or oficial high school transcript to this application.
PART V: CONCUSSION AND HEAD INJURY TRAINING REQUIREMENT
Attach the original certiicate of completion of the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program (CCEP).
PART VI: COMPLETION OF REQUIRED COACHING COURSE
(For individuals NOT holding a valid Connecticut educator certiicate, or a standard or permanent certiicate)
Course completed at: |
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Date course completed: |
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(Name of college/university or board of education) |
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PART VII: RENEWAL OF
Have you completed at least 15 clock hours of seminars, course work or workshops which provide |
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YES |
information on safe and healthful coaching practices and understanding child and adolescent development |
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as approved by the State Department of Education? |
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NO
On or after July 1, 2010, through June 30, 2015, completion of the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program (CCEP).
After July 1, 2015, completion of the refresher course completed through the CCEP.
PART VIII: 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). I further certify that I have attained the age of at least 18 years.
ORIGINAL SIGNATURE OF APPLICANT
DATE:
Original Signature Must Be On Form Submitted
PAGE 2
ED 185 CONNECTICUT STATE DEPARTMENT OF EDUCATION
REV. 1/12 |
Bureau of Educator Standards and Certiication |
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C.G.S. |
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C.G.S.
C.G.S.
C.G.S.
Regs.
P.O. Box 150471 – Room 243
Hartford, CT
www.ct.gov/sde
INSTRUCTIONS TO APPLICATION FOR
Listed below are the required documents which must be submitted to the Bureau of Educator Standards and Certiication to process your request for the issuance or renewal of a
For the ISSUANCE of a
Applicant:
1. If you do NOT hold a valid Connecticut educator certiicate, or a standard or permanent certiicate, please com- plete sections a through g of the instructions below.
2. If you hold a valid Connecticut educator certiicate, or a standard or permanent certiicate, please complete sec- tions a, b, c, f and g of the instructions below.
Instructions:
a. Complete Parts I through VI and Part VIII of the application. (Applicants who hold a valid Connecticut educator certiicate, or a standard or permanent certiicate, need not complete Parts IV or VI).
b. Attach a photocopy of your valid Standard First Aid card, or original certiicate of completion. The Standard First Aid course must be completed within three years prior to the date of application. Please remember to sign your
Standard First Aid card prior to photocopying.
c. Attach a photocopy of your valid CPR card, or original certiicate of completion. Please remember to sign your
CPR card prior to photocopying.
d. Attach a photocopy of your high school diploma or its equivalent. An oficial high school transcript may be sub-
mitted in lieu of a copy of your diploma.
e. Oficial transcript/certiicate verifying the completion of an approved coaching course.
f. Attach the original certiicate of completion of the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program (CCEP).
g. Return completed application and attachments to the Bureau of Educator Standards and Certiication.
(continued)
Information on this application is subject to disclosure pursuant to the Freedom of Information Act.
For the RENEWAL of a
Instructions:
a. Complete Parts I through III and Parts VII and VIII.
b. Attach a photocopy of your Standard First Aid card, or original certiicate of completion. The Standard First Aid course must be valid for the renewal date of the permit. Please remember to sign your Standard First Aid
card prior to photocopying.
c. Attach a photocopy of your CPR card, or original certiicate of completion, valid for the renewal date of the permit after course. Please remember to sign your CPR card prior to photocopying.
d. On or after July 1, 2010, through June 30, 2015, attach original certiicate of completion of the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program (CCEP). After July 1, 2015, attach oficial veriication of the refresher course completed through the CCEP.
e. Return completed application and attachments to the Bureau of Educator Standards and Certiication.
NOTE: Please do NOT submit veriication of completion of the required 15 clock hours of seminars, course work or workshops for the renewal of the
Please submit the application for renewal no sooner than six months prior to the expiration date of your current permit.
How to contact the Bureau of Educator Standards and Certiication:
teacher.cert@ct.gov |
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Website: |
www.ct.gov/sde |
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FAX: |
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PHONE: |
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(To speak with a staff member, call the IVR weekdays, between |
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Common mistakes
When completing the Connecticut Ed 185 form, applicants often make several common mistakes that can delay the processing of their applications. One frequent error is failing to use blue ink and uppercase letters when filling out personal information. The form specifically requests this, and not adhering to these instructions can result in the application being returned for correction.
Another common mistake involves omitting the required signatures. Applicants must sign their first aid and CPR cards before submission. If these signatures are missing, it may cause delays in processing or lead to outright rejection of the application.
Many applicants also overlook the necessity of attaching official documents. For instance, a copy of the high school diploma or official transcript is required. Failing to include these documents can lead to significant delays, as the application will not be considered complete without them.
Inaccurate or incomplete answers to the questions regarding criminal history and professional conduct can create problems. If an applicant answers "YES" to any of the questions, they must provide a signed statement of explanation. Neglecting to do so can result in the application being flagged or denied.
Another mistake is not keeping track of the expiration dates of the required certifications. The first aid and CPR courses must be completed within a specific timeframe. If these certifications are expired, the application will not be processed until the requirements are met.
Some applicants fail to provide the necessary documentation for the concussion and head injury training requirement. The original certificate from the Connecticut Coaching Education Program (CCEP) must be attached. Without this documentation, the application cannot proceed.
Additionally, applicants often neglect to double-check the completion of all required parts of the form. Missing even one section can lead to delays. Each part of the application must be filled out thoroughly to ensure it is processed without issues.
Lastly, submitting the application too early can also be a mistake. Applicants should not submit their renewal applications more than six months before the expiration date of their current permit. Doing so may lead to unnecessary complications and delays in processing.
Key takeaways
- Complete the form accurately: Fill out the Connecticut Ed 185 form using blue ink and uppercase letters. Ensure that all personal information is correct to avoid delays in processing.
- Required documents: Gather and attach all necessary documents, such as your First Aid and CPR cards, high school diploma or transcript, and concussion training certificate.
- Criminal history disclosure: Be aware that you must answer questions regarding any past criminal convictions or professional disciplinary actions. If you answer "yes," provide a detailed explanation.
- First Aid and CPR courses: Ensure that your First Aid and CPR courses were completed within the last three years. Sign your cards before submitting photocopies.
- Concussion training: Complete the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program and attach the original certificate of completion.
- Renewal process: For permit renewal, complete Parts I through III and Parts VII and VIII of the application. Submit your documents at least six months before your current permit expires.
- Do not submit extra documents: When renewing your permit, do not include verification of the required 15 clock hours of additional training. This may be requested later during an audit.
- Contact information: If you have questions or need assistance, reach out to the Bureau of Educator Standards and Certification via email, phone, or their website.
Similar forms
The Connecticut Ed 185 form is similar to the Application for a Teaching Certificate in that both documents require personal information and verification of qualifications. Just like the Ed 185, the teaching certificate application asks for details such as name, address, and social security number. Both forms also require applicants to disclose any criminal history or disciplinary actions. This ensures that individuals entering the education field meet the necessary standards for safety and integrity.
Another document that shares similarities with the Ed 185 form is the First Aid Certification Application. This application also necessitates the completion of a first aid course and requires proof of certification. Just as the Ed 185 mandates that applicants attach a copy of their first aid card, the First Aid Certification Application asks for similar documentation to verify that the applicant has completed the necessary training within a specified time frame.
The CPR Certification Application mirrors the Ed 185 in its requirement for proof of CPR training. Both documents emphasize the importance of safety in educational settings. Applicants must provide documentation of their CPR course completion, just like they do for the first aid course on the Ed 185. This ensures that individuals working with children are equipped to handle emergencies effectively.
The Concussion Awareness Training Certificate is another document that parallels the Ed 185 form. Both require proof of training related to health and safety in sports. The Ed 185 specifically mandates completion of a concussion training module, while the Concussion Awareness Training Certificate serves as evidence that an individual has received the necessary education on this critical topic. This focus on safety reflects a commitment to protecting student athletes.
The Background Check Authorization Form is similar to the Ed 185 in that both require applicants to undergo a criminal history check. Just as the Ed 185 includes questions about past criminal convictions, the Background Check Authorization Form serves to gather consent for the necessary checks. This step is crucial for maintaining a safe environment for students and ensuring that educators meet legal requirements.
The Child Abuse and Neglect Registry Check is another document closely related to the Ed 185 form. Both require verification that applicants have not been involved in any child abuse or neglect cases. The Ed 185 specifies that applicants must submit to a check of this registry, emphasizing the importance of safeguarding children in educational settings. This requirement aligns with broader efforts to ensure the safety and well-being of students.
The Professional Development Plan aligns with the Ed 185 in terms of ongoing education requirements. Both documents highlight the necessity for educators to engage in continuous learning and improvement. The Ed 185 requires applicants to complete a certain number of clock hours in relevant seminars or workshops, while a Professional Development Plan outlines specific goals and activities to enhance an educator's skills and knowledge over time.
The New York Mobile Home Bill of Sale form is an important legal document that facilitates the transfer of ownership of a mobile home, ensuring clarity and legal recognition in the transaction. Completion of this form protects the rights of both the seller and the buyer, making it essential in real estate processes. For those seeking guidance on this matter, Templates and Guide can provide valuable resources to navigate the complexities of creating a proper bill of sale.
The Coaching License Application shares similarities with the Ed 185 form, as both are designed for individuals seeking to coach in educational settings. Each application requires proof of relevant training and certifications, such as first aid and CPR. The emphasis on safety and proper training in both documents ensures that coaches are prepared to support student athletes effectively and responsibly.
Lastly, the Athletic Trainer Certification Application is akin to the Ed 185 in its focus on ensuring that individuals working with student athletes are properly trained and certified. Both documents require applicants to provide proof of relevant coursework and certifications. The shared goal of promoting safety and health in sports is evident in the requirements outlined in both applications, reflecting a commitment to the well-being of students involved in athletics.