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Free Ed 186 PDF Template

The ED 186 form is an application for a Temporary Emergency Coaching Permit issued by the Connecticut State Department of Education. This form is essential for individuals seeking to coach in Connecticut schools when certified coaches are unavailable. Completing the form accurately is crucial for a smooth application process; start by filling out your personal information and ensure all required documents are attached.

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The ED 186 form is a crucial document for individuals seeking a Temporary Emergency Coaching Permit in Connecticut. This application requires personal information, including the applicant's name, social security number, and contact details. It also includes questions about any past criminal convictions or disciplinary actions related to professional credentials, ensuring that applicants meet the state’s standards for safety and integrity. Furthermore, the form mandates proof of completion for several essential courses, such as First Aid, CPR, and concussion training. Applicants must also provide documentation of their high school education. For those looking to renew their permit, additional requirements include proof of enrollment in an approved coaching course or evidence of completed coursework. Each section of the form must be filled out carefully, and signatures are required to affirm the accuracy of the information provided. The application process is designed to ensure that all coaches are adequately prepared and qualified to support student-athletes effectively.

▼ Ed 186 PDF Form

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File Information

Fact Name	Description
Purpose	The ED 186 form is used to apply for a Temporary Emergency Coaching Permit in Connecticut.
Governing Laws	The application is governed by Connecticut General Statutes Sections 10-145, 10-145d, 10-149, and 10-149b.
First Aid Requirement	Applicants must complete a first aid course within one year prior to applying and provide proof of completion.
Criminal Background Check	Applicants are subject to a criminal history record check as mandated by Connecticut General Statutes Section 10-221d.
Renewal Process	To renew the permit, applicants must demonstrate completion of required coaching courses or instruction hours.

Ed 186 Sample


ED 186	CONNECTICUT STATE DEPARTMENT OF EDUCATION
ED 186	CONNECTICUT STATE DEPARTMENT OF EDUCATION
REV. 7/19	Bureau of Educator Standards and Certification
C.G.S. 10-145	P.O. Box 150471
C.G.S. 10-145d	Hartford, CT 06115-0471
C.G.S. 10-149	Hartford, CT 06115-0471
C.G.S. 10-149b	www.ct.gov/sde/cert
Regs. 10-145d-424
	APPLICATION FOR TEMPORARY EMERGENCY COACHING PERMIT

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

LAST NAME

FIRST NAME

GENDER

SOCIAL SECURITY NUMBER

BIRTH DATE (Month-Day-Year) - Required

ADDRESS (Street)

Apt. #

(City)

(State)

FORMER LAST NAME(S)

(Zip Code)

PHONE

(Home)

Race/Ethnicity 1.

Native American

Asian/Pacific Islander

Black

(Work)

White

(Optional)

Hispanic

E-MAIL ADDRESS

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

YES

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

YES

3. 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?

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 use.

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

PAGE 1

ED 186

PART II: COMPLETION OF REQUIRED FIRST AID COURSE

The first aid course must have been completed with 1 year prior to the date of application. Please sign your first aid card and attach: (1) a photocopy of both the front and back of the first aid card, or (2) original certificate of completion, to this application.


Name of course completed	Date of completion

PART III: COMPLETION OF REQUIRED CPR COURSE

The CPR course must have been completed within 1 year prior to the date of application. Please sign your CPR card and attach: (1) a photocopy of both the front and back of the CPR card, or (2) original certificate 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 official high school transcript to this application.

PART V: CONCUSSION AND HEAD INJURY TRAINING REQUIREMENT

Attach the original certificate of completion of the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program (CCEP).

PART VI: RENEWAL OF COACHING PERMIT

Complete this section ONLY if you are requesting renewal of the Temporary Emergency Coaching Permit.

1.Provide proof of enrollment in an approved coaching course;

2.Attach an official transcript verifying the completion of at least two (2) semester hours of credit in an approval coaching course;

3.Provide verification of completion of 30 clock hours of instruction in an approved coaching course.

PART VII: APPLICANT ATTESTATION

I have reviewed this application and affirm that the information provided by me on this application and any accompanying documents contains no material misrepresentations, falsifications or omissions and that all 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.

ORIGINAL SIGNATURE OF APPLICANT:

DATE:

Original Signature Must Be On Form Submitted

PAGE 2

ED 186

PART VIII: EMPLOYING AGENT ATTESTATION

A. Check one:

Initial Permit

Renewal

I am requesting issuance of a Temporary Emergency Coaching Permit for the _________________ school year. This request is made on

the basis of my determination that no certified teacher possessing a coaching permit or noncertified individual possessing a coaching permit is available for the position and that the applicant meets all requirements for issuance of the permit. The applicant will be supervised and assisted, as appropriate, by regular observation, guidance and evaluation of performance.

B. For RENEWAL request, also complete this section:

Renewal of the Temporary Emergency Coaching Permit is requested for the following school year:_________________________

The applicant has served successfully as a coach during the school year:__________________________________

C.Signature of Superintendents or Designee required for all requests:

Signature of Superintendent, Executive Director or Designee			Date
(Original Signature: No Signature Stamps Accepted)

Type or Printed Name of Person Signing Above			Title
Employing Agent			Telephone
Street
Street			E-mail Address
City	State	Zip Code

PAGE 3

ED 186	CONNECTICUT STATE DEPARTMENT OF EDUCATION
REV. 7/19	Bureau of Educator Standards and Certification
C.G.S. 10-145	P.O. Box 150471
C.G.S. 10-145d	Hartford, CT 06115-0471
C.G.S. 10-149	Hartford, CT 06115-0471
C.G.S. 10-149b	www.ct.gov/sde/cert
Regs. 10-145d-424
	INSTRUCTIONS TO APPLICATION FOR
	TEMPORARY EMERGENCY COACHING PERMIT

Applicant:

For the ISSUANCE of the Temporary Emergency Coaching Permit you must complete and submit the following:

a. Complete Parts I through V, and Part VII.

b. Attach a photocopy of your Standard First Aid card, or original certificate of completion, verifying the successful completion of the Standard First Aid course within one year prior to the date of application. Please remember to sign your Standard

First Aid card prior to photocopying.

c. Attach a photocopy of your CPR card, or original certificate of completion, verifying the successful completion of the CPR course within one year prior to the date of application. Please remember to sign your CPR card prior to photocopying.

d. Attach a photocopy of your high school diploma or its equivalent. Your official high school transcript may be submitted in lieu of a copy of your diploma.

e. Attach the original certificate of completion of the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program (CCEP).

f. Return completed application to the superintendent of schools.

For the RENEWAL of the Temporary Emergency Coaching Permit, please complete Parts I, through III, V, through VII.

Employing Agent:

For the ISSUANCE of the Temporary Emergency Coaching Permit:

a.Complete Part VIII, sections A and C. Please mail application and supporting documentation to the Bureau of Educator Standards and Certification.

For the RENEWAL of the Temporary Emergency Coaching Permit:

b.Complete Part VIII, sections A, B, and C. Please mail application and supporting documentation to the Bureau of Educator Standards and Certification.

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

Common mistakes

Completing the ED 186 form can be a straightforward process, yet many applicants make common mistakes that can lead to delays or even denials. One prevalent error is failing to use blue ink and uppercase letters as specified in the instructions. This requirement is crucial because it ensures clarity and uniformity in the application, making it easier for reviewers to process the information. Neglecting this detail can result in the application being returned for correction.

Another frequent mistake involves incomplete personal information. Applicants sometimes overlook filling out all required fields, such as the social security number or birth date. Each piece of information is essential for verification purposes. Omitting any of these details can stall the application process, causing unnecessary frustration for the applicant.

Additionally, many individuals fail to attach the necessary documentation. For instance, the form requires copies of the first aid and CPR certifications, as well as proof of high school education. Without these attachments, the application cannot be processed. It is vital to double-check that all required documents are included before submission.

Some applicants also misinterpret the questions regarding past convictions or disciplinary actions. It is essential to answer these questions truthfully and completely. If there are any "yes" answers, a signed statement of explanation must accompany the application. Failing to provide this information can lead to serious consequences, including denial of the permit.

Another common oversight is not signing the application. The original signature is required on the form, and electronic signatures or stamps are not acceptable. This requirement emphasizes the importance of personal accountability and verification of the information provided.

Moreover, applicants sometimes neglect to follow the specific instructions for renewal applications. Each section must be completed accurately, and all required documentation must be attached. Missing even one detail can result in delays or the need to resubmit the application.

In the section regarding concussion and head injury training, applicants often forget to include the original certificate of completion. This training is a critical component of the coaching permit application, and its absence can lead to disqualification from consideration.

Finally, some individuals fail to review their application thoroughly before submission. A final check can help identify any errors or omissions that may have been overlooked. Taking the time to ensure that all information is accurate and complete can save applicants from potential setbacks.

By being mindful of these common mistakes, applicants can enhance their chances of a smooth application process for the ED 186 form. Attention to detail and adherence to instructions are key to successfully obtaining a Temporary Emergency Coaching Permit.

Key takeaways

When applying for the ED 186 form, understanding the requirements and processes is essential. Here are some key takeaways to help you navigate the application effectively:

Complete Personal Information Accurately: Ensure that all personal information is filled out in blue ink and in uppercase letters. This includes your name, contact details, and social security number.
Criminal History Disclosure: Be prepared to answer questions regarding any past criminal convictions or disciplinary actions. If you answer "YES" to any question, a signed statement of explanation must be attached.
First Aid and CPR Requirements: Both First Aid and CPR courses must be completed within one year prior to your application. Attach a photocopy of your certification cards or original certificates of completion.
Educational Documentation: Include a copy of your high school diploma or an official transcript with your application. This is a crucial step in verifying your educational background.
Employing Agent's Role: The employing agent must complete the attestation section. Their signature is required to confirm that no certified individuals are available for the coaching position.

By following these guidelines, applicants can ensure a smoother process when filling out and submitting the ED 186 form. Proper preparation and attention to detail can make a significant difference in your application experience.

Similar forms

The ED 186 form, used for applying for a Temporary Emergency Coaching Permit in Connecticut, shares similarities with the Application for a Teaching Certificate. Both documents require detailed personal information, including the applicant's name, social security number, and educational background. Each form also includes sections that assess the applicant's fitness for the role, such as questions about criminal history and prior disciplinary actions. Additionally, both applications necessitate supporting documentation, like transcripts or proof of completed courses, ensuring that applicants meet the necessary qualifications for their respective educational roles.

In addition to the forms mentioned, another critical document is the Bill of Sale, which can be instrumental when purchasing equipment or resources for educational purposes. It ensures that all transactions are documented, protecting both the buyer and the seller by outlining the specific terms of the sale. For more information about the Bill of Sale form, you can refer to https://nyforms.com/bill-of-sale-template/.

Another document akin to the ED 186 is the Application for Substitute Teacher Permit. This form also collects personal information and requires background checks to ensure the safety of students. Both applications emphasize the importance of educational qualifications, asking for proof of completion of relevant training or coursework. Furthermore, the substitute teacher permit application, like the ED 186, must be signed by a school administrator, affirming the need for the applicant's services in a teaching capacity.

The ED 186 form is also similar to the Application for Special Education Certification. Both documents require extensive personal details and background checks to safeguard vulnerable populations. Each application includes sections dedicated to verifying the applicant's educational history and training, which are crucial for ensuring competency in specialized teaching roles. Both forms also require the applicant to affirm the truthfulness of the information provided, highlighting the importance of integrity in the application process.

The Application for Coaching Authorization is another document that resembles the ED 186. This form is specifically designed for individuals seeking to coach in educational settings and, like the ED 186, requires proof of completion of first aid and CPR training. Both applications necessitate a signed attestation from the employing agent, confirming the need for the applicant's coaching skills. The focus on safety and preparedness in both documents underscores the critical nature of these roles in student development.

Additionally, the Application for a Professional Educator License shares commonalities with the ED 186 form. Both require comprehensive personal information and a verification process that includes background checks. Each application also mandates the submission of supporting documents, such as proof of educational qualifications and professional development courses. The emphasis on maintaining high standards in educational roles is evident in both forms, ensuring that applicants are well-prepared for their responsibilities.

Lastly, the Application for an Administrator Certificate is similar to the ED 186 form in that both require applicants to provide personal information and undergo background checks. Each document includes sections that assess the applicant's qualifications and experience in education. Furthermore, both forms require a signed attestation from a supervising official, reinforcing the collaborative nature of educational roles and the importance of administrative oversight in maintaining quality standards within educational institutions.