Part I, Personal Information: print all information in blue ink and in uppercase letters.
Note: if you answer "YES" to any of the above questions, you must attach a signed statement of explanation.
Part IV: do not include student teaching, substitute or paraprofessional experience.
Notes: the Bureau of Educator Standards and Certification will notify you by e-mail if additional credentials are required.
| Question | Answer |
|---|---|
| Form Name | Form ED 170 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 231 |
| Avg. time to fill out | 39 min |
| Edition | Rev 10/25 |
| Issuing agency | Connecticut State Department of Education |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | ED 170, ED170, ED-170, Form ED 170, General Application for Certificate |
| Official source | Form ED 170 (Rev 10/25), Connecticut State Department of Education |
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