Form ED 174 at a glance
What it is: Form ED 174 is the Connecticut State Department of Education application for substitute teacher authorization for candidates who have not completed a bachelor's degree.
Where and when to file: Employing Agent: complete Part IV and mail the application and supporting documentation to the Bureau of Educator Standards and Certification, P.O. Box 150471 Hartford, CT 06115-0471.
This checklist must be attached to the complete application packet. The required documents must be submitted to the Bureau of Educator Standards and Certification, P.O. Box 150471 Hartford, CT 06115-0471, to process the request for a Substitute Teacher Authorization for candidates who have NOT completed a bachelor's degree.
A filled-in Form ED 174 example: a candidate fills out Part I
How to fill out Form ED 174, box by box
Last name, first name, MI and gender
In Part I, print all information in blue ink and in uppercase letters.
Enter the LAST NAME, the FIRST NAME, the MI and the GENDER.
Social security number and birth date
Enter the SOCIAL SECURITY NUMBER and the BIRTH DATE (Month-Day-Year) - Required.
Address and former last names
Enter the ADDRESS (Street) and Apt. #, then the (City), (State) and (Zip Code), and the FORMER LAST NAME(S).
Phone, race or ethnicity and e-mail address
Enter the PHONE (Home) and the PHONE (Work), and the E-MAIL ADDRESS.
Enter the Race/Ethnicity as one number (Optional): 1. Native American 2. Asian/Pacific Islander 3. Black 4. White 5. Hispanic.
Crime, dismissal and surrender questions
Mark YES or NO to 1. Have you ever been convicted of any crime, excluding minor traffic violations?
Mark YES or NO to 2. Have you been dismissed for cause from any position?
Mark YES or NO to 3. Have you ever surrendered a professional certificate, license, permit or other credential (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?
If you answer YES to any of the YES or NO questions in Part I, 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.
Educational background and experience
In Part II, list all education you have completed, including high school, trade-related vocational school and/or other postsecondary schooling, with the NAME OF SCHOOL, the STATE, the DATES ATTENDED From (M/Y) To (M/Y) and the 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 qualifications for the substitute position. (Please attach your resume, or a separate sheet, if necessary.)
Applicant attestation and signature
In Part III, you certify that the information provided by you on this application and any accompanying documents contains no material misrepresentations, falsifications or omissions and that all of the information given by you is true, complete and accurate.
All application and accompanying information may be verified and any material misrepresentation, falsification or omission may result in the denial or revocation of your 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; then enter the ORIGINAL SIGNATURE OF APPLICANT and the DATE.
Part IV: employing agent
Part IV: EMPLOYING AGENT INFORMATION AND ATTESTATION, with the Signature of Superintendent or designee attesting to the accuracy of information (Original signature, no stamps accepted).
Original Signatures Must Be On Form Submitted.
More rules for Form ED 174
This authorization will expire on June 30 of the school year during which it was approved.
Common questions about Form ED 174
Where do I file it?
Applicant: complete Parts I and II, then return the completed application to the superintendent of schools, executive director or designee.
Sources
[1] Form ED 174 (REV. 7/19), Connecticut State Department of Education (the Official source link on this page).