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The Connecticut Ed 170 form is a crucial document for individuals seeking certification as educators in the state. This application requires essential personal information, including your name, social security number, and contact details. Applicants must also disclose any past criminal convictions or professional dismissals, ensuring transparency in their background. A nonrefundable fee of $50 is required, which must be submitted in the form of a money order or certified check. The form includes sections for listing educational history and work experience, emphasizing the importance of a solid professional background. Additionally, applicants must indicate the specific endorsements they are seeking, which can cover various subjects and grade levels. This form plays a significant role in the certification process, as it is subject to verification and may require additional documentation, such as transcripts and statements of professional experience. By completing the Ed 170 form accurately and thoroughly, applicants take an important step toward contributing to Connecticut's educational landscape.

Documents used along the form

The Connecticut Ed 170 form is essential for those seeking educator certification in Connecticut. Alongside this form, several other documents may be required to complete the application process. Each of these documents serves a specific purpose and provides important information to the State Department of Education. Below is a list of commonly used forms and documents that accompany the Ed 170 form.

  • ED 125 Statement of Preparing Higher Education Institution: This document verifies that the applicant has completed an educator preparation program at an accredited institution.
  • ED 126 Statement of Professional Experience: Applicants with prior teaching experience must submit this form to confirm their professional background and the validity of their out-of-state certification.
  • ED 179 Form: This form is for the continuation of a Connecticut Professional Educator Certificate, used when an applicant is seeking to extend their certification.
  • ED 183 Form: This document is necessary for the renewal of an Initial Educator Certificate, allowing educators to maintain their teaching credentials.
  • Operating Agreement: For LLCs looking to establish clear business protocols, our comprehensive Operating Agreement template provides essential guidelines for operation and management.
  • Official Transcripts: Applicants must submit official transcripts from their colleges or universities to demonstrate completion of required coursework for certification.
  • Criminal History Record Check Authorization: This form allows the State Police Bureau of Investigation to conduct a background check on the applicant, as mandated by state law.
  • Child Abuse and Neglect Registry Consent: Applicants must provide consent for a check against the Department of Children and Families’ registry to ensure the safety of students.
  • Application Fee Payment: A nonrefundable fee of $50 must be submitted with the application. This payment can be made via a certified bank check or money order.

Each of these documents plays a crucial role in the certification process. It is important for applicants to ensure they have all necessary paperwork completed and submitted to avoid delays in obtaining their educator certification in Connecticut.

Preview - Connecticut Ed 170 Form

GENERAL APPLICATION FOR CERTIFICATE
PART I: PERSONAL INFORMATION (Print all information in blue ink and in uppercase letters.)
LAST NAME
FIRST NAME MI GENDER
SOCIAL SECURITY NUMBER BIRTH DATE (Month-Day-Year) - Required
ADDRESS (Street ONLY no P.O. Box) Apt. #
(City) (State)
(Zip Code) FORMER LAST NAME(S) Required
PHONE
(Home/Cell)
(Work)
E-MAIL ADDRESS
1. Haveyoueverbeenconvictedofanycrime,excludingminortracviolations? YES NO
2. Haveyoubeendismissedforcausefromanyposition? YES NO
3. Haveyoueversurrenderedaprofessionalcerticate,license,permitorothercredential YES NO
(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10-232d,theStateBoardofEducationmustsubmit,periodically,adatabaseofapplicants
foraninitialissuanceofacerticate,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certicate,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certicate,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ocialcopiesofcourtoradministrativerecord(s),
includingdispositionofeachuse.
CONNECTICUT STATE DEPARTMENT OF EDUCATION
Bureau of Educator Standards and Certication
P.O. Box 150471
Hartford, CT 06115-0471
www.ct.gov/sde/cert
ED 170
REV. 10/25
C.G.S.10-145
C.G.S.10-145d
PAGE 1
˗ ˗
˗ ˗
˗ ˗
˗ ˗
Race/Ethnicity
(Required)
˗
1. Native American
2. Asian/PacicIslander
3. Black
4. White
5. Hispanic
ED 170
PART II: LIST CERTIFICATION ENDORSEMENTS REQUESTED (See enclosed code list.)
ENDORSEMENT #1 ENDORSEMENT #2 ENDORSEMENT #3 ENDORSEMENT #4
Checkboxifbilingualendorsementissoughtforabovediscipline(s).
Ifrequestingendorsement090,098,pleaseindicatethespecicoccupational/vocationalarea(e.g.,carpentry)
PART III: EDUCATIONAL BACKGROUND
LIST THE NAMES OF COLLEGES OR UNIVERSITIES ATTENDED
Name of Institution State Major Field Year of College Credit or
of Study Graduation Degree Awarded
PART IV: LIST TEACHING, ADMINISTRATIVE OR SPECIAL SERVICE EXPERIENCE
Please provide your education and work (within the last ten years) history, starting with your most recent position. Do not
include student teaching, substitute or paraprofessional experience. Attach an additional sheet of paper, if needed.
NAME OF SCHOOL LOCATION
(City, State)
JOB TITLE SUBJECT/FIELD GRADE(S) DATES EMPLOYED
FROM (M/Y) TO (M/Y)
PART V: DO YOU HOLD/HAVE YOU HELD AN OUT-OF-STATE CERTIFICATE? YES NO
(specifystateandtypeofcerticate)
(Attach a copy of both sides of out-of-state certicates, covering any of the experiences listed above that are within the
last 10 years.)
PART VII: APPLICANT ATTESTATION
Icertifythattheinformationprovidedbymeonthisapplicationandanyaccompanyingdocumentscontainsnomaterial
misrepresentations,falsications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veriedandthatanymaterialmisrepresentation,
falsicationoromissionmayresultinthedenialorrevocationofmycerticate(s),permit(s)orauthorization(s).
ORIGINAL SIGNATURE OF APPLICANT: DATE:
Information on this application is subject to disclosure pursuant to the Freedom of Information Act.
PAGE 2
Teaching Endorsements
010 Business,4–12
015 English,4–12
018 French,4–12
019 German,4–12
020Italian,4–12
021Latin,4–12
022Russian,4–12
023Spanish,4–12
024 OtherWorldLanguage,4–12
026History&SocialStudies,4–12
029Mathematics,4–12
030Biology,4–12
031Chemistry,4–12
032Physics,4–12
033EarthScience,4–12
034GeneralScience,4–12
035DriverEducation
040Agriculture,Pre-K–12
041VocationalAgriculture,4–12
042Art,PK–12
043Health,PK–12
044PhysicalEducation,PK–12
045HomeEconomics,PK–12
047TechnologyEducation,PK–12
049Music,PK–12
055PartiallySighted,PK–12
057DeafandHardofHearing,PK–12
059Blind,PK–12
062SchoolLibraryMediaSpecialist
072SchoolNurse-Teacher
073SchoolDentalHygienist-Teacher
089MarketingEducation,4–12
101WorldLanguageInstructor,Elementary
102RemedialReading&RemedialLanguageArts,1–12
104CooperativeWorkEducation/DiversiedOccupations
110 UniqueSubject-Area
111TeachingEnglishtoSpeakersofOtherLanguages(TESOL),PK–12
112IntegratedEarlyChildhood/SpecialEd.,Birth–Kindergarten
113IntegratedEarlyChildhood/SpecialEd.,Nursery-K–Elem.1–3
165ComprehensiveSpecialEducation,K–12
215English,MiddleSchool
226History&SocialStudies,MiddleSchool
229Mathematics,MiddleSchool
230Biology,MiddleSchool
231Chemistry,MiddleSchool
232Physics,MiddleSchool
233 Earth Science, Middle School
234GeneralScience,MiddleSchool
235IntegratedScience,MiddleSchool
305Elementary,PK–6
317 Portuguese,4–12
318 MandarinChinese,4–12
483 Dance,Pre-K–12
485 TheatreandDrama,Pre-K–12
511 Montessori,Elementary,1–6
512 Montessori,Primary,BirthtoKindergarten
826 VocationalDepartmentHead:TradeTechnology
ED 170
CONNECTICUT ENDORSEMENT CODES
Administrative Endorsements
085SchoolBusinessAdministrator
092IntermediateAdministrationorSupervision
093SuperintendentofSchools
097ReadingandLanguageArtsConsultant
105DepartmentChairperson
Adult Education Endorsements
088Non-EnglishSpeakingAdults
106HighSchoolCreditDiplomaProgram
107ExternalDiplomaProgram/NoncreditMandatedPrograms
Special Services Endorsements
061SpeechandLanguagePathologist
068SchoolCounselor
070SchoolPsychologist
071SchoolSocialWorker
268 SchoolMarriage&FamilyTherapist
Vocational Endorsements
082VocationalTechnicalAdministrator
090OccupationalSubject,VocationalTechnicalSchools
091Trade-RelatedSubjects,VocationalTechnicalSchools
098Trade&IndustrialOccupations–ComprehensiveHighSchool
103HealthOccupations–ComprehensiveHighSchool
108PracticalNurseEducationInstruction
109HealthOccupations–VocationalTechnicalSchools
001Pre-K–Grade8
002Pre-K–Grade6
003Pre-K–Grade3
004Grades1–8
005ElementaryEducation,1–6
006MiddleGrades,4–8
007AcademicSubjects
008Pre-KandKindergarten
009Bilingual,PK–12
011LicensedPracticalNurse
013Elementary,K–6
016English,7–9
017Speech,7–12
025History,7–12
027SocialStudies,7–12
028History&SocialStudies,7–9
036CoreCurriculum
037Psychology,7–12
038Sociology,7–12
039SecondarySubject
046VocationalHomeEconomics,PK–12
048Librarian,7–12
050SpecialSubject
051MentallyHandicapped1–12
052MentallyHandicapped7–12
053PhysicallyHandicapped,1–12
054PhysicallyHandicapped,7–12
056PartiallySighted,7–12
058Deaf,7–12
060Blind,7–12
063SpecialTeacherofReading,1–8
064SpecialTeacherofReading,7–12
065ComprehensiveSpecialEducation,PK–12
066GuidanceCounselor–Elementary
067GuidanceCounselor–Secondary
069PsychologicalExaminer
074ElementaryPrincipal
075GeneralSupervisor–Elementary
076SecondaryPrincipal
077GeneralSupervisor–Secondary
078Principal–CombinedSchool
079SpecialSupervisor
080AdministrativeAssistant
081SuperintendentofSchools
083SpecialAdministrative
086DirectorofAdultEducation(FullTime)
087DirectorofAdultEducation(PartTime)
094AdultEducation
095EducationSupervisor(StateDepartment)096
265 ComprehensiveSpecialEducation,1–12
**Certication Codes No Longer Issued. These codes may only be renewed by current endorsement holders**
INSTRUCTIONS FOR GENERAL APPLICATION FOR CERTIFICATION
Use this form for all requests EXCEPT:
•renewalofaConnecticutProfessionalEducatorCerticate(pleaseuseFormED179);or
•renewalofanInitialEducatorCerticate(pleaseuseFormED183).
A. For First-Time Applicants (Initial Educator Certicate):
• completeandsignapplication;
• submitocialtranscript(s)viaU.S.mail;e-transcriptsmustbesubmitteddirectlybythecollege(s)/universityto:
teacher.etranscript@ct.gov;
• submitED-125StatementofPreparingHigherEducationInstitution;and/or
• submitED-126StatementofProfessionalExperienceandcopyofout-of-statecerticate/licenseforapplicantswithpriorteaching
experience.
B. For Advancement to a Professional Educator Certicate:
• completeandsignapplication;
• submitpaymentof$375intheformofamoneyorder,cashier’scheck,orcertiedbankcheckpayableto“Treasurer,Stateof
Connecticut,”orpaymentmaybemadeonlineviacreditcard.Personalchecksarenotaccepted;
• submitocialtranscript(s)viaU.S.mailverifyingadditionalrequiredcoursework;e-transcriptsmustbesubmitteddirectlybythe
college(s)/universitytoteacher.etranscript@ct.gov; and
• submitED-126StatementofProfessionalExperienceverifying50monthsofsuccessfulserviceinaConnecticutpublicschoolor
approvednonpublicschool,underanInitialand/orProvisionalCerticate.
C. Cross Endorsement if You Hold a Connecticut Teacher Certicate:
• completeandsignapplication;
• submitpaymentof$100(perendorsement)intheformofamoneyorder,cashier’scheck,orcertiedbankcheckpayableto
“Treasurer,StateofConnecticut,”orpaymentmaybemadeonlineviacreditcard.Personalchecksarenotaccepted;
• submitocialtranscript(s)forcourseworkapplicabletoendorsementsought;and
• verifysuccessfulcompletionofapplicabletestingrequirements.
D. For Advancement of an Adult Education Certicate to the Professional Level:
• completeandsignapplication;
• submitpaymentof$100intheformofamoneyorder,cashier’scheck,orcertiedbankcheckpayableto“Treasurer,Stateof
Connecticut,”orpaymentmaybemadeonlineviacreditcard.Personalchecksarenotaccepted;
• submitocialtranscript(s)viaU.S.mail;e-transcriptsmustbesubmitteddirectlybythecollege(s)toteacher.etranscript@ct.gov;
and
• submitED-126StatementofProfessionalExperienceverifying50monthsofsuccessfulserviceteachingadulteducationina
Connecticutpublicschool,underanInitialand/orProvisionalCerticate.
NOTES:
• TheBureauofEducatorStandardsandCerticationwillnotifyyoubye-mailifadditionalcredentialsarerequired.Ensureyouhave
providedacurrent,accuratee-mailaddress.
• Retainaphotocopyofallapplicationmaterialsforyourrecords.
How to contact the Bureau of Educator Standards and Certication:
E-mail:teacher.cert@ct.gov
Website:www.ct.gov/sde/cert
Fax:860-713-7017
Phone:860-713-6969MondayandThursdaybetween12-2p.m.atallothertimes24-hourautomatedphonesystem
(To speak with a sta member anytime during the greeting, press zero two times.)
CONNECTICUT STATE DEPARTMENT OF EDUCATION
Bureau of Educator Standards and Certication
P.O. Box 150471
Hartford, CT 06115-0471
www.ct.gov/sde/cert
ED 170
REV. 10/25
C.G.S.10-145
C.G.S.10-145d

Common Questions

1. What is the purpose of the Connecticut Ed 170 form?

The Connecticut Ed 170 form is used to apply for an initial educator certificate, authorization, or permit in the state of Connecticut. It is essential for individuals seeking to enter the teaching profession or advance their certification status within the state. Completing this form accurately is crucial for ensuring that applicants meet the necessary qualifications and standards set by the Connecticut State Department of Education.

2. What is the application fee for the Ed 170 form?

The application fee for submitting the Ed 170 form is $50. This fee must be paid in the form of a money order, cashier’s check, or certified bank check, made payable to the “Treasurer, State of CT.” It is important to note that personal checks and cash are not accepted, and the fee is nonrefundable.

3. What information is required on the Ed 170 form?

Applicants must provide personal details such as their full name, social security number, date of birth, and contact information. Additionally, the form requires information about any past criminal convictions, professional dismissals, or disciplinary actions related to previous certifications. Educational history, including the names of colleges attended and degrees awarded, must also be documented.

4. Are there any specific endorsements available through the Ed 170 form?

Yes, the Ed 170 form allows applicants to request various endorsements based on their areas of expertise. Endorsements cover a wide range of subjects and grade levels, including but not limited to mathematics, science, language arts, and special education. Applicants can check a box if they seek a bilingual endorsement for the disciplines they are applying for.

5. What should I do if I have a criminal record?

If an applicant has a criminal record, they must answer “YES” to the relevant question on the form. It is necessary to attach a signed statement explaining the circumstances, including any multiple incidents. Official copies of court or administrative records must also be submitted, detailing the disposition of each case. Transparency in this matter is crucial for the application process.

6. How can I submit my transcripts?

Transcripts should be submitted directly from the college or university to the Connecticut State Department of Education. Electronic transcripts (e-transcripts) can expedite processing times and should be sent to teacher.etranscript@ct.gov. If submitting paper transcripts, ensure they are official copies and include all relevant coursework and degrees awarded.

7. How will I be notified about the status of my application?

Once the Ed 170 form is submitted, the Bureau of Educator Standards and Certification will communicate with applicants via email regarding the status of their application. This may include notifications about any additional credentials or documentation that may be required. Therefore, it is vital to provide a current and accurate email address on the application.

Guide to Filling Out Connecticut Ed 170

Completing the Connecticut Ed 170 form is a crucial step for individuals seeking certification in education within the state. Following these steps will help ensure that the application is filled out accurately and submitted correctly.

  1. Obtain the Ed 170 form from the Connecticut State Department of Education website or your local education office.
  2. Gather the required information, including your full name, social security number, birth date, and contact details.
  3. Indicate your gender and any former last names, if applicable.
  4. Provide your address, ensuring that you include the street address without using a P.O. Box.
  5. Complete the questions regarding criminal convictions, employment dismissals, and any professional credential actions. If you answer "YES" to any question, prepare a signed statement of explanation.
  6. Select your race/ethnicity from the provided options. This step is optional.
  7. List the endorsements you are seeking, checking the box if you are requesting a bilingual endorsement.
  8. Provide details of the colleges or universities you attended, including the name of the institution, major field of study, and the year of graduation.
  9. Detail your work history for the last ten years, excluding student teaching and substitute experience. Include the name of the school, location, job title, subject/field, grade levels, and dates employed.
  10. Sign and date the application, certifying that all information is true and complete.
  11. Prepare a nonrefundable application fee of $50 in the form of a money order, cashier’s check, or certified bank check made payable to "Treasurer, State of CT." Personal checks and cash are not accepted.
  12. Submit the completed form along with the application fee and any required supporting documents to the address provided on the form.

After submitting your application, you will receive notification from the Bureau of Educator Standards and Certification regarding any additional requirements or the status of your application. It is essential to keep a copy of your completed application and any accompanying documents for your records.

Dos and Don'ts

When filling out the Connecticut Ed 170 form, it is essential to approach the process with care and attention to detail. Here are ten important dos and don'ts to consider:

  • Do read the instructions thoroughly before starting the application.
  • Do ensure that you have the correct application fee of $50 in the form of a money order or certified check.
  • Do provide your full legal name and any former names accurately.
  • Do include your Social Security number and birth date as required.
  • Do attach any necessary documentation if you answer "YES" to any of the conviction or dismissal questions.
  • Don't use personal checks or cash for the application fee; only accepted forms are money orders or certified checks.
  • Don't leave any required fields blank; ensure all information is complete.
  • Don't forget to sign and date the application before submission.
  • Don't submit unofficial transcripts; ensure that all transcripts are official and sent directly from the institution.
  • Don't neglect to keep a photocopy of your completed application and all supporting documents for your records.