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The ED 179 form is a crucial document for educators seeking to maintain their professional certification in Connecticut. This application, issued by the Connecticut State Department of Education, serves as a means for educators to provide essential personal information, including their name, social security number, and contact details, all of which must be printed clearly in blue ink. Additionally, applicants are required to disclose their professional experience, indicating whether they have served under their current Professional Educator Certificate and providing details about their positions within Connecticut's educational system. A significant aspect of the ED 179 form is the requirement for a criminal history records check, which aims to ensure the safety and integrity of the educational environment. Applicants must answer questions regarding any past convictions or disciplinary actions related to their professional credentials, and if any affirmative responses are given, a detailed explanation must accompany the application. This process underscores the commitment to maintaining high standards in education and safeguarding the welfare of students. The form also includes an attestation section where applicants affirm the accuracy of the information provided, emphasizing the importance of honesty and transparency in the certification process.
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File Information
| Fact Name | Description |
|---|---|
| Form Title | ED 179 is the application for the continuation of a Professional Educator Certificate in Connecticut. |
| Governing Body | This form is issued by the Connecticut State Department of Education. |
| Revision Date | The form was last revised in March 2013. |
| Legal Reference | The governing law for this form is Connecticut General Statutes Section 10-145b. |
| Criminal Background Check | Applicants must undergo a criminal history records check as required by C.G.S. Section 10-221d. |
| Child Abuse Registry Check | A check of the Department of Children and Families’ child abuse and neglect registry is also required. |
| Disclosure Requirement | Information provided in this application is subject to disclosure under the Freedom of Information Act. |
| Signature Requirement | Applicants must provide an original signature on the form when submitting it. |
| Experience Documentation | If applicable, a separate form ED 126 must be submitted to document professional experience. |
Ed 179 Sample
ED 179 |
CONNECTICUT STATE DEPARTMENT OF EDUCATION |
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REV. 3/13 |
Bureau of Educator Standards and Certiication |
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C.G.S. |
P.O. Box 150471 – Room 243 |
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as amended by PA |
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Hartford, CT |
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Sec. 36 |
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www.ct.gov/sde/cert |
APPLICATION FOR CONTINUATION OF PROFESSIONAL EDUCATOR CERTIFICATE
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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(State) |
(Zip Code) |
PHONE |
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(Home) |
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(Work) |
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MI |
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GENDER (M/F) |
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– |
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BIRTH DATE
(Apt #)
FORMER LAST NAME(S)
Race/Ethnicity 1. Native American
2.Asian/Paciic Islander
3.Black
(Optional) 4. White
5. Hispanic
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1. |
Have you ever been convicted of any crime, excluding minor trafic violations? |
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YES |
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2. |
Have you ever been dismissed for cause from any position? |
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YES |
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3. |
Have you ever surrendered a professional certiicate, license, permit or other credential |
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YES |
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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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NO NO NO
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 179
PART II: STATEMENTS OF PROFESSIONAL EXPERIENCE
Check the appropriate box to indicate service under your current Professional Educator Certiicate.
A.
B.
I have not served under my current Professional Educator Certiicate for a Board of Education.*
I have served under my current Professional Educator Certiicate in the following positions for a Connecticut Board
of Education.
If you checked “B,” please complete the Grid below. Also, please submit form ED 126 signed by the superintendent, documenting experience under your current Professional Educator Certiicate. A separate form ED 126 must be submitted for each district in which you were employed under this Professional Educator Certiicate.
Form ED 126 is available at www.ct.gov/sde/certapps.
Employing |
Position Held |
Grade |
Certiication |
Check Below if: |
Dates of Service |
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District |
(e.g., teacher, |
Level |
Endorsement |
Full- |
Part- |
From |
To |
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administrator, social |
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Required for |
Time |
Time |
(Month/ |
(Month/ |
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worker, substitute) |
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Position |
(50% or |
(less |
Year) |
Year) |
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more) |
than |
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50%) |
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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:
*Board of Education means a Connecticut local or regional Board of Education, regional educational service center, uniied school district, cooperative arrangement established pursuant to
Original Signatures Must Be On Form Submitted
PAGE 2
Common mistakes
Completing the ED 179 form is a critical step for educators seeking to maintain their professional certification in Connecticut. However, many applicants encounter common pitfalls that can delay or jeopardize their application. Understanding these mistakes can help ensure a smoother process.
One frequent error involves incomplete personal information. Applicants often neglect to fill in all required fields, such as their social security number or birth date. Omitting this information can lead to processing delays, as the State Board of Education may require additional documentation to verify identity.
Another common mistake is using incorrect ink color. The instructions specify that all information should be printed in blue ink. Using black or any other color can result in the form being rejected, necessitating a resubmission.
Many applicants also fail to provide a signed statement of explanation when answering "YES" to any of the background questions. This oversight can have serious consequences, as the application may be considered incomplete without the necessary documentation. Each incident must be detailed separately, which requires careful attention to ensure compliance.
In addition, neglecting to attach official documentation is a common issue. When there are incidents involving previous certifications or licenses, applicants must submit court or administrative records. Failure to include these documents can lead to immediate denial of the application.
Another mistake involves misunderstanding the employment history section. Applicants sometimes check the wrong box regarding their service under the current Professional Educator Certificate. This can misrepresent their experience and may complicate the verification process, leading to potential issues with their application.
Moreover, not completing the ED 126 form can be detrimental. Each district where the applicant has worked must have a signed ED 126 form submitted. Omitting this step can result in incomplete verification of professional experience, which is essential for the renewal process.
Some applicants also struggle with the attestation statement. They may fail to read and understand the implications of signing the statement, which certifies that all provided information is accurate. Misrepresentation, whether intentional or accidental, can lead to serious repercussions, including revocation of certification.
Lastly, failing to keep a copy of the submitted application can create problems down the line. Without a record, applicants may find it challenging to follow up on their application status or address any issues that arise during the review process.
By avoiding these common mistakes, applicants can enhance their chances of successfully renewing their Professional Educator Certificate. Thoroughly reviewing the form and following all instructions meticulously will lead to a more efficient application process.
Key takeaways
When filling out the ED 179 form for the continuation of your Professional Educator Certificate, there are several important points to keep in mind:
- Accuracy is Crucial: Ensure that all personal information is printed clearly in blue ink and in uppercase letters. Mistakes or unclear information can delay processing.
- Disclosure of Criminal History: Be prepared to answer questions regarding any past criminal convictions or disciplinary actions. If you answer “YES” to any question, you must provide a signed statement of explanation and official records.
- Professional Experience Documentation: If you have served under your current certificate, complete the required grid accurately. Remember to submit form ED 126 for each district where you were employed.
- Original Signatures Required: The application must include your original signature. Make sure to sign the form before submission, as electronic signatures will not be accepted.
Completing the ED 179 form accurately and thoroughly is essential for a smooth renewal process. Take the time to review each section carefully to avoid any issues that could impact your certification status.
Similar forms
The ED 179 form is similar to the Form I-9, which is used by employers to verify the identity and employment authorization of individuals hired for employment in the United States. Like the ED 179, the Form I-9 requires personal information, including name, address, and social security number. Both forms necessitate the applicant's attestation regarding the accuracy of the information provided, and they require supporting documentation to verify the applicant's claims, ensuring compliance with legal standards.
Another document comparable to the ED 179 is the FAFSA (Free Application for Federal Student Aid). The FAFSA collects personal and financial information to determine eligibility for federal student aid. Similar to the ED 179, it requires detailed information about the applicant, including social security number and demographic details. Both forms also emphasize the importance of accuracy and honesty, with potential penalties for providing false information.
For those navigating the motorcycle sales process, understanding the required documentation is key to a smooth transaction. Both buyers and sellers should be aware of specific forms needed and their significance in the transfer of ownership. The Templates and Guide offer invaluable resources to help individuals ensure they meet legal requirements, thus facilitating a successful sale while protecting both parties involved.
The ED 179 also shares similarities with the Form W-4, which employees use to indicate their tax situation to their employer. Both documents require personal information, including name and address, and both have sections where the applicant must affirm the truthfulness of their information. The W-4 allows for adjustments based on personal circumstances, much like how the ED 179 allows for the reporting of professional experience.
In addition, the ED 179 resembles the state-specific professional licensing applications, which require individuals to submit personal information, professional history, and affirmations of truthfulness. These applications often include questions regarding criminal history and disciplinary actions, similar to the inquiries on the ED 179. Both forms serve to ensure that applicants meet the necessary qualifications for their respective fields.
The ED 179 is also akin to the Certificate of Good Standing, which is often required for various professional licenses. This document verifies that an individual is in compliance with state regulations and has not faced disciplinary actions. Like the ED 179, it requires personal details and often demands supporting documentation to confirm the applicant's standing within their profession.
Lastly, the ED 179 has similarities to the application for a driver's license. Both forms require personal information, including name, address, and date of birth. They also involve an attestation that the information provided is accurate. Additionally, both applications may require documentation to verify identity and residency, ensuring that the applicant meets the necessary legal requirements to hold a license.