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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, issued by the Connecticut State Department of Education, outlines the necessary steps and requirements for applicants. It begins with gathering personal information, such as name, social security number, and contact details, ensuring that all entries are made clearly and accurately. Applicants must also disclose any past criminal convictions or disciplinary actions related to their professional credentials, as the State Board of Education conducts thorough background checks. Furthermore, the form requires proof of completion for essential courses, including first aid, CPR, and concussion training, all of which must be updated within specific time frames. Additional documentation, such as high school diplomas or transcripts, may also be necessary depending on the applicant's educational background. For those renewing their permits, a record of continued education in safe coaching practices is required, demonstrating a commitment to the health and well-being of student-athletes. By carefully following the instructions laid out in the Ed 185 form, applicants can navigate the certification process with confidence and clarity.

Documents used along the form

When applying for the Connecticut Ed 185 form, several other documents may be necessary to ensure a complete application. Each of these documents plays a crucial role in verifying the qualifications and compliance of the applicant. Below is a list of commonly required forms and documents that accompany the Ed 185 form.

  • First Aid Certification: This document serves as proof that the applicant has completed a certified first aid course within the last three years. A photocopy or original certificate must be attached to the application.
  • CPR Certification: Similar to the first aid certification, this document confirms that the applicant has successfully completed a CPR course. A signed photocopy or original certificate is required for submission.
  • Quitclaim Deed Form: For individuals looking to transfer property ownership in Texas, it is important to include the Texas Documents form as part of the necessary documentation for a seamless transfer process.
  • High School Diploma or Transcript: Applicants must provide a copy of their high school diploma or an official high school transcript. This helps verify the educational background of the applicant.
  • Concussion and Head Injury Training Certificate: This certificate, obtained from the Connecticut Coaching Education Program (CCEP), demonstrates that the applicant has completed the necessary training on concussion and head injury management.
  • Coaching Course Completion Certificate: For those who do not hold a valid Connecticut educator certificate, proof of completion of an approved coaching course is required. This verifies that the applicant has received adequate training in coaching practices.
  • Signed Statement of Explanation: If an applicant answers "yes" to certain questions regarding criminal history or professional conduct, a signed statement detailing the circumstances must be included. This document provides context and clarity to the application.
  • Verification of 15 Clock Hours of Training: While not submitted with the initial application, this document may be required later for renewal. It confirms that the applicant has completed the necessary professional development hours related to coaching.
  • Application Fee: Depending on the specific requirements, a fee may be necessary when submitting the application. This fee supports the processing of the Ed 185 form and associated documents.

Gathering these documents can seem overwhelming, but each one is essential for ensuring that applicants meet the necessary standards for coaching in Connecticut. By preparing these materials in advance, applicants can streamline their application process and focus on their commitment to coaching and mentoring young athletes.

Download PDF Form

Preview - Connecticut Ed 185 Form

 

 

 

 

ED 185

CONNECTICUT STATE DEPARTMENT OF EDUCATION

 

 

 

REV. 1/12

Bureau of Educator Standards and Certiication

 

 

 

C.G.S. 10-145 C.G.S. 10-145d

P.O. Box 150471 – Room 243

C.G.S. 10-149 C.G.S. 10-149b

Hartford, CT 06115-0471

Regs. 10-145d-423

www.ct.gov/sde

 

APPLICATION FOR FIVE-YEAR RENEWABLE COACHING PERMIT

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

LAST NAME

FIRST NAME

–

 

 

 

–

 

 

 

 

 

SOCIAL SECURITY NUMBER

ADDRESS (Street)

(City)

MI

 

 

GENDER (M/F)

–

 

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTH DATE (Month-Day-Year) – Required

(Apt #)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORMER LAST NAME(S)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(State)

 

 

(Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHONE

 

 

 

 

 

 

 

 

–

 

 

 

 

 

 

 

 

 

 

 

–

 

 

 

 

 

 

 

 

 

 

Race/Ethnicity

1.

Native American

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Home/Cell)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Asian/Paciic Islander

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Black

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Optional)

4.

White

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

Hispanic

 

1.

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

YES

NO

2.

Have you ever been dismissed for cause from any position?

 

 

 

 

 

 

YES

NO

3.

Have you ever surrendered a professional certiicate, 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 10-221d, 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 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:

 

Date course completed:

 

(Name of college/university or board of education)

 

PART VII: RENEWAL OF FIVE-YEAR RENEWABLE COACHING PERMIT

Have you completed at least 15 clock hours of seminars, course work or workshops which provide

 

YES

information on safe and healthful coaching practices and understanding child and adolescent development

 

 

as approved by the State Department of Education?

 

 

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

 

C.G.S. 10-145

 

C.G.S. 10-145d

C.G.S. 10-149

C.G.S. 10-149b

Regs. 10-145d-423

P.O. Box 150471 – Room 243

Hartford, CT 06115-0471

www.ct.gov/sde

INSTRUCTIONS TO APPLICATION FOR

FIVE-YEAR RENEWABLE COACHING PERMIT

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 Five-Year Renewable Coaching Permit.

For the ISSUANCE of a Five-Year Renewable Coaching Permit you must complete and submit the following:

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 Five-Year Renewable Coaching Permit:

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 Five-Year Renewable Coaching Permit with this application. Applicants selected for a random audit will be notiied in writing, and be required to submit veriication.

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:

E-mail:

teacher.cert@ct.gov

Website:

www.ct.gov/sde

FAX:

860-713-7017

24-hour Interactive Voice Response (IVR) for applicants.

PHONE:

860-713-6969

 

(To speak with a staff member, call the IVR weekdays, between 1-5 p.m.)

Common Questions

1. What is the Connecticut Ed 185 form used for?

The Connecticut Ed 185 form is an application for a Five-Year Renewable Coaching Permit. This permit allows individuals to coach in Connecticut schools. It is essential for those who want to ensure they meet the state’s requirements for coaching, including training in first aid, CPR, and concussion awareness.

2. What documents do I need to submit with the Ed 185 form?

You must submit several documents to complete your application. These include a valid Standard First Aid card or original certificate, a valid CPR card or original certificate, a copy of your high school diploma or official transcript, and the original certificate for concussion and head injury training. If you do not hold a valid Connecticut educator certificate, additional documents related to your coaching course completion will also be required.

3. How often do I need to renew my coaching permit?

The coaching permit must be renewed every five years. To renew, you need to complete specific requirements, including ongoing education related to safe coaching practices and child development. It’s important to submit your renewal application no sooner than six months before your current permit expires to ensure you maintain your eligibility to coach.

4. What happens if I answer "yes" to any background questions on the form?

If you answer "yes" to any of the background questions regarding convictions or disciplinary actions, you must attach a signed statement explaining the situation. It is crucial to provide complete and accurate information. Failure to do so may result in the denial or revocation of your permit. Be prepared to submit official copies of any relevant court or administrative records as well.

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Guide to Filling Out Connecticut Ed 185

Filling out the Connecticut Ed 185 form requires careful attention to detail. After completing the form, it must be submitted along with specific documentation to the Bureau of Educator Standards and Certification. Ensure that all required signatures and copies are included to avoid delays in processing.

  1. Print all information in blue ink and in uppercase letters in Part I: Personal Information. Include your last name, first name, social security number, address, gender, birth date, and contact information.
  2. Indicate your race/ethnicity by checking the appropriate box.
  3. Answer the questions regarding criminal history and professional conduct. If you answer “YES” to any question, prepare a signed statement of explanation and attach any relevant court or administrative records.
  4. Complete Part II by providing details of your First Aid course. Attach a photocopy of your First Aid card or the original certificate of completion.
  5. In Part III, provide information about your CPR course. Attach a photocopy of your CPR card or the original certificate of completion.
  6. For Part IV, attach a copy of your high school diploma or official high school transcript.
  7. In Part V, attach the original certificate of completion for the concussion and head injury training requirement from the Connecticut Coaching Education Program (CCEP).
  8. If applicable, complete Part VI regarding the required coaching course and attach the official transcript or certificate verifying completion.
  9. In Part VII, confirm completion of the required seminars, coursework, or workshops for permit renewal, if applicable.
  10. Complete Part VIII by signing and dating the application to certify the accuracy of the information provided.
  11. Compile all attachments and return the completed application to the Bureau of Educator Standards and Certification at the specified address.

Dos and Don'ts

When filling out the Connecticut Ed 185 form, there are several important practices to follow to ensure a smooth application process. Below are six essential dos and don'ts.

  • Do print all information in blue ink and in uppercase letters.
  • Do attach all required documents, such as your first aid and CPR cards, signed and photocopied.
  • Do complete all relevant sections of the form based on whether you hold a valid Connecticut educator certificate.
  • Do ensure that all information provided is accurate and truthful to avoid delays or denials.
  • Don't leave any sections blank; every question must be answered.
  • Don't forget to sign your application; an original signature is required.