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Fill Your Connecticut Ed 174 Form

The Connecticut Ed 174 form is an application for substitute teacher authorization specifically designed for candidates who have not yet completed a bachelor's degree. This form is a crucial step for individuals seeking to work as substitute teachers in Connecticut schools, allowing them to demonstrate their qualifications and background. If you are ready to begin your journey in education, please fill out the form by clicking the button below.

Prepare Connecticut Ed 174 Here

Article Structure

The Connecticut Ed 174 form serves as a crucial application for individuals seeking authorization to work as substitute teachers, particularly those who have not yet completed a bachelor's degree. This form is structured into several parts, beginning with personal information that requires applicants to provide their name, contact details, and demographic data, including race and ethnicity. Additionally, the form includes important questions regarding any criminal history or professional disciplinary actions, which are essential for ensuring the safety and integrity of the educational environment. Applicants must also detail their educational background, including high school and any vocational training, as well as any relevant experience working with school-age children. A significant aspect of the Ed 174 is the attestation section, where applicants affirm the truthfulness of their submitted information, acknowledging that any inaccuracies could lead to denial or revocation of their authorization. Furthermore, the form necessitates the involvement of an employing agent, typically a school superintendent or executive director, who must verify the applicant's information and endorse the application. Lastly, the Ed 174 outlines specific instructions and a checklist of required documents to ensure a complete submission, emphasizing the importance of thoroughness in the application process.

Documents used along the form

The Connecticut Ed 174 form is an important document for individuals seeking authorization to work as substitute teachers without having completed a bachelor’s degree. To support this application, several other forms and documents are often required. Below is a list of these documents, each with a brief description to clarify their purpose and importance in the application process.

Criminal Background Check Authorization: This document allows the State Board of Education to conduct a criminal history records check on the applicant. It is a crucial step to ensure the safety of students.
Child Abuse and Neglect Registry Check: Applicants must submit to a check of the Department of Children and Families’ registry. This helps to confirm that the individual has not been involved in any child abuse or neglect incidents.
Signed Statement of Explanation: If the applicant answers "yes" to any questions regarding past criminal activity or disciplinary actions, a signed statement is required. This statement must provide details about the incidents.
Real Estate Purchase Agreement: A crucial document for defining the terms of real estate transactions, ensuring that both parties' rights and obligations are outlined. To learn more and access the form, visit Texas Documents.
Official Court Records: In cases where the applicant has a criminal history, official copies of court records must be submitted. These documents should include the disposition of each case to provide a complete picture of the applicant's background.
Resume: A resume detailing the applicant’s educational background and relevant work experience with school-age children is often required. This helps to demonstrate qualifications for the substitute teaching position.
Transcripts: Official transcripts from all educational institutions attended may be required to verify the applicant's educational achievements and qualifications.
Employment Verification Letters: Letters from previous employers can serve as proof of the applicant's experience working with children. These letters may enhance the application by providing references.
Application Checklist: This checklist ensures that all necessary documents are included with the application. It helps applicants verify that they have completed all required steps before submission.

Gathering these documents is essential for a smooth application process. Each document serves a specific purpose and contributes to the overall assessment of the applicant's suitability for a substitute teaching position. Ensuring that all required materials are submitted will help facilitate a timely review by the Bureau of Educator Standards and Certification.

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Preview - Connecticut Ed 174 Form

	ED 174	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 1/12	Bureau of Educator Standards and Certiication
	C.G.S. 10-145, P.A. 11-27	P.O. Box 150471 – Room 243
	C.G.S. 10-145d	P.O. Box 150471 – Room 243
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-420	Hartford, CT 06115-0471
		www.ct.gov/sde

APPLICATION FOR SUBSTITUTE TEACHER AUTHORIZATION

FOR CANDIDATES WHO HAVE NOT COMPLETED A BACHELOR’S DEGREE

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

LAST NAME

FIRST NAME

GENDER (M/F)

–

SOCIAL SECURITY NUMBER

BIRTH DATE (Month-Day-Year) – Required

ADDRESS (Street)

(Apt #)

(City)

–

FORMER LAST NAME(S)

(State)

(Zip Code)

PHONE

–

Race/Ethnicity

Native American

(Home/Cell)

Asian/Paciic Islander

E-MAIL ADDRESS

Black

(Optional)

White

Hispanic

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

YES

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

YES

Have you ever surrendered a professional certiicate, 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 complete a criminal history records check on each applicant for an initial issuance or renewal of a certiicate, authorization or permit. Each applicant seeking an initial issuance or renewal of a certiicate, 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 a criminal history records check the database of all persons who hold any certiicate, 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 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 174

PART II: EDUCATIONAL BACKGROUND

List all education you have completed, including high school, trade-related vocational school and/or other postsecondary schooling.

NAME OF SCHOOL

STATE DATES ATTENDED

From (M/Y) To (M/Y)

EDUCATION LEVEL COMPLETED

(H.S. Diploma, GED, Assoc. Degree)

List ALL substitute teaching experience or any other experiences you have had working with school-age children, along with any unique qualiications for the substitute position. (Please attach your resume, or a separate sheet, if necessary.)

PART III: 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:

PART IV: EMPLOYING AGENT INFORMATION AND ATTESTATION

The applicant will serve only as a substitute teacher in random assignments and only up to 40 days in one assignment.

Signature of Superintendent, Executive Director or designee attesting to the accuracy of information

(Original Signature: No Signature Stamps Accepted)

Typed or Printed Name of Person Signing Above

District

Street

City,

State, Zip Code

FOR OFFICE USE ONLY

The person named on this application is authorized of education listed above.

Authorized Signature:

Date

Title

Telephone

FAX Number

E-mail Address

is NOT authorized to serve as a substitute teacher for the board

Date:

Original Signatures Must Be On Form Submitted

PAGE 2

ED 174	CONNECTICUT STATE DEPARTMENT OF EDUCATION
REV. 1/12	Bureau of Educator Standards and Certiication
REV. 1/12
C.G.S. 10-145, P.A. 11-27	P.O. Box 150471 – Room 243
C.G.S. 10-145d	P.O. Box 150471 – Room 243
Regs. 10-145d-420	Hartford, CT 06115-0471
	Hartford, CT 06115-0471
	www.ct.gov/sde

INSTRUCTIONS TO APPLICATION FOR SUBSTITUTE TEACHER AUTHORIZATION

FOR CANDIDATES WHO HAVE NOT COMPLETED A BACHELOR’S DEGREE

THIS CHECKLIST MUST BE ATTACHED TO THE COMPLETE APPLICATION PACKET

Listed below are the required documents which must be submitted to the Bureau of Educator Standards and Certi- ication to process your request for a Substitute Teacher Authorization for candidates who have NOT completed a bachelor’s degree. This authorization will expire on June 30 of the school year during which it was approved.

Applicant:

a. Complete Parts I, II and III.

b. Return completed application to the superintendent of schools, executive director or designee.

Employing Agent:

a. Complete Part IV and mail application and supporting documentation to the Bureau of Educator Standards and Certiication at the above address.

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

Common Questions

What is the Connecticut Ed 174 form used for?

The Connecticut Ed 174 form is an application for a Substitute Teacher Authorization specifically designed for candidates who have not completed a bachelor's degree. This form allows individuals to apply for the ability to serve as substitute teachers in Connecticut schools, provided they meet certain requirements. The authorization is essential for those looking to gain experience in educational settings while pursuing further qualifications.

Who is eligible to apply using the Ed 174 form?

Eligibility to apply for the Substitute Teacher Authorization using the Ed 174 form generally includes individuals who have completed at least a high school diploma or equivalent. However, applicants must not have completed a bachelor's degree. Additionally, the form requires applicants to disclose any past criminal convictions or disciplinary actions related to their professional credentials, which may impact their eligibility.

What information do I need to provide on the Ed 174 form?

The form requires personal information such as your name, address, social security number, and contact details. You will also need to provide educational background information, including the names of schools attended, dates of attendance, and the highest level of education completed. Furthermore, any substitute teaching experience or relevant work with school-age children should be detailed. This information helps the State Board of Education assess your qualifications.

What happens if I answer "yes" to the criminal history questions?

If you answer "yes" to any of the criminal history questions on the Ed 174 form, you must attach a signed statement explaining the circumstances. This includes providing official copies of court or administrative records related to each incident. Transparency is crucial, as any misrepresentation could lead to denial or revocation of your authorization. The State Board of Education conducts thorough background checks, so honesty is paramount.

How long is the Substitute Teacher Authorization valid?

The Substitute Teacher Authorization obtained through the Ed 174 form is valid until June 30 of the school year in which it was approved. This means that if you receive your authorization during the academic year, you will need to renew it before the next school year starts if you wish to continue substituting. Keeping track of the expiration date is essential to ensure uninterrupted eligibility.

What should I do after completing the Ed 174 form?

Once you have completed the Ed 174 form, you must return it to the superintendent of schools, executive director, or their designee. They will need to complete a section of the form before sending it along with any supporting documentation to the Bureau of Educator Standards and Certification. Make sure to include all required documents to avoid delays in processing your application.

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Guide to Filling Out Connecticut Ed 174

Filling out the Connecticut Ed 174 form is an important step in applying for a Substitute Teacher Authorization. Completing this form requires careful attention to detail to ensure that all information is accurate and complete. Following the steps outlined below will help you navigate the process smoothly.

Personal Information: In Part I, print your last name, first name, middle initial, gender, social security number, birth date, address, former last names, phone number, and email address in dark ink and uppercase letters.
Race/Ethnicity: Select your race/ethnicity from the provided options.
Criminal History Questions: Answer the questions regarding criminal history and professional credential actions. If you answer "YES" to any question, prepare a signed statement of explanation and include official copies of relevant records.
Educational Background: In Part II, list all educational experiences, including high school and any vocational or postsecondary schooling. Provide the name of the school, state, dates attended, and the education level completed.
Experience with Children: List all substitute teaching experience or any other relevant experiences working with school-age children. Attach your resume or a separate sheet if necessary.
Applicant Attestation: In Part III, sign and date the application, certifying that all information is true and complete.
Employing Agent Information: The superintendent or executive director must complete Part IV. They should provide their signature, typed or printed name, and district information.
Submission: Ensure that all parts of the application are completed and attach the required documents. Submit the application to the appropriate employing agent, who will then mail it to the Bureau of Educator Standards and Certification.

Once the form is submitted, the Bureau of Educator Standards and Certification will review your application. It is essential to keep copies of all documents for your records. Be prepared for potential follow-up requests for additional information or clarification.

Dos and Don'ts

Things to Do When Filling Out the Connecticut Ed 174 Form:

Print all information clearly in dark ink and uppercase letters.
Provide your complete personal information, including your last name, first name, and social security number.
Attach any required documentation, such as a signed statement of explanation if you answer "YES" to any background questions.
List all education and substitute teaching experience accurately.
Sign the application to certify that the information is true and complete.
Submit the application to the appropriate employing agent for further processing.

Things to Avoid When Filling Out the Connecticut Ed 174 Form:

Do not leave any required fields blank.
Avoid using pencil or light ink when filling out the form.
Do not include any false information or misrepresentations.
Refrain from submitting the application without the necessary attachments.
Do not forget to have the employing agent complete their section of the form.
Do not use signature stamps; original signatures are required.