Connecticut Ed 177 Form – Fill Out and Use This PDF

The Connecticut Ed 177 form is a vital document used by educators and teaching professionals seeking the Durational Shortage Area Permit (DSAP). This permit, applicable when a certified candidate is not available for a specific position, offers a unique avenue for teaching opportunities within the state's education system. To ensure a streamlined application process, individuals and institutions must meticulously complete the designated sections and meet all outlined requirements before the commencement of employment.

To take the first step towards securing a DSAP and contributing to Connecticut's educational landscape, click the button below to fill out the Connecticut Ed 177 form.

Get Form Now Download PDF

Connecticut Ed 177 Form PDF Details

The Connecticut Ed 177 form is a crucial document for educators seeking the Durational Shortage Area Permit (DSAP), enabling schools to fill teaching positions in areas experiencing a shortage of qualified candidates. Initiated by the employing school or district, rather than the candidate, this application plays a pivotal role in maintaining educational standards while addressing staffing challenges. The form outlines specific steps and documentation required from candidates, including parts to be filled out by the candidate, school or district officials, and educator preparation providers, depending on the individual's circumstances and qualifications. Besides the initial issuance, it also details the process for the reissuance of the DSAP, ensuring that candidates continue to meet the necessary criteria over time. Attachment requirements, such as evidence of enrollment and official transcripts, are clearly specified for each party involved, streamlining the process for applicants and ensuring that the Bureau of Educator Standards and Certification receives all necessary information to make informed decisions. Moreover, the form includes a comprehensive list of Connecticut endorsement codes, covering a wide range of teaching specializations, further exemplifying its role in facilitating a diverse and well-equipped teaching workforce across the state.

Question	Answer
Form Name	Connecticut Ed 177 Form
Form Length	10 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min 30 sec
Other names	area dsap form search, application dsap, application durational shortage dsap, ed177

Form Preview Example

		INSTRUCTIONS – PAGE 1
	ED 177	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 9/20	Bureau of Educator Standards and Certification
	C.G.S. 10-145	P.O. Box 150471
	C.G.S. 10-145d	P.O. Box 150471
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422
		www.ct.gov/sde/cert
		INSTRUCTIONS FOR FORM ED 177

APPLICATION FOR FIRST ISSUANCE OF THE DURATIONAL SHORTAGE AREA PERMIT (DSAP)

A Durational Shortage Area Permit (DSAP) may be requested by the school or district if a position cannot be filled by an appropriately certified candidate. An application for issuance of a DSAP cannot be initiated by the applicant. The effective date of the DSAP may be the date the original ED 177 is received, provided all requirements for issuance have been met on or before this date. An

ED 177 must be submitted prior to the first day of employment.

Please complete the appropriate section of the checklist below.

CANDIDATE

a. Complete Parts I, II, and III of the application form (ED 177).

b. Attach official transcripts showing the completion of at least 12 semester hours of credit in the subject for which the DSAP is requested. An official transcript showing the completion of a bachelor’s degree must be included if the candidate has never held certification in Connecticut.

SCHOOL OR DISTRICT OFFICIAL

The application form (ED 177) and supporting documentation must be submitted by the employing agent to the Bureau of Educator Standards and Certification. The “Evidence of Enrollment” form ED 177 (Attachment) may be submitted separately.

a. Complete Parts IV and V of the application form (ED 177).

b. Complete the “Evidence of Enrollment” form ED 177 (Attachment) – Part A, if applicable. If this part is required, return the

Attachment to the candidate for signature by the appropriate higher education official where the candidate is enrolling in a teacher preparation program or the Alternate Route to Certification program. The Attachment need not be completed if the candidate holds a valid Connecticut certificate and is completing course work under a DSAP to fulfill requirements for a cross endorsement (except for endorsements 102, 112 or 113), or if the candidate has at least 20 school months of successful appropriate* teaching experience in an approved nonpublic school.

EDUCATOR PREPARATION PROVIDER

a. Complete the “Evidence of Enrollment” form ED 177 (Attachment) – Part B and Part C, if applicable. The Attachment need not be completed if the candidate holds a valid Connecticut educator certificate and is completing course work under a DSAP to fulfill requirements for a cross endorsement (except for endorsements 102, 112 or 113), or if the candidate has at least 20 school months of successful appropriate* teaching experience in the same approved nonpublic school.

*The twenty months must be in the subject area or field for which the initial educator certificate will be sought (CT State Regulation 10-145d-412 (3)(A)).

		INSTRUCTIONS – PAGE 2
	ED 177	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 9/20	Bureau of Educator Standards and Certification
	C.G.S. 10-145	P.O. Box 150471
	C.G.S. 10-145d	P.O. Box 150471
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422
		www.ct.gov/sde/cert

APPLICATION FOR REISSUANCE OF THE DURATIONAL SHORTAGE AREA PERMIT (DSAP)

A Durational Shortage Area Permit (DSAP) may be requested by the employing agent of a board of education if a position cannot be filled by an appropriately certified candidate. An application for issuance of a DSAP cannot be initiated by the applicant. The effective date of the DSAP will be the date the original ED 177 is received, provided all requirements for issuance have been met on or before this date. An ED 177 must be submitted prior to the first day of employment.

The following checklist outlines the sections of the form to be completed and documents which must be submitted by the employing agent in order for the Bureau of Educator Standards and Certification to determine eligibility for a DSAP.

CANDIDATE

a. Complete Parts I, II, and III of the application form (ED 177).

b. Attach official transcripts showing the completion of at least nine semester hours of credit during the validity period of the previous DSAP in the subject for which the DSAP is requested.

SCHOOL OR DISTRICT OFFICIAL

The application form (ED 177) and supporting documentation must be submitted by the employing agent to the Bureau of Educator Standards and Certification. The Attachment may be submitted separately.

a. Complete Parts VI and VII of the application form (ED 177).

b. Complete the “Evidence of Enrollment” form ED 177 (Attachment) – Part A, if applicable. If this part is required, return the

EDUCATOR PREPARATION PROVIDER

*The twenty months must be in the subject area or field for which the initial educator certificate will be sought (CT State Regulation 10-145d-412 (3)(A)).

INSTRUCTIONS – PAGE 3

ED 177

CONNECTICUT ENDORSEMENT CODES

Teaching Endorsements

010Business, 7–12

015English, 7–12

018French, 7–12

019German, 7–12

020Italian, 7–12

021Latin, 7–12

022Russian, 7–12

023Spanish, 7–12

024Other World Language, 7–12

026History & Social Studies, 7–12

029Mathematics, 7–12

030Biology, 7–12

031Chemistry, 7–12

032Physics, 7–12

033Earth Science, 7–12

034General Science, 7–12

035Driver Education

040Agriculture, Pre-K–12

041Vocational Agriculture, 7–12

042Art, PK–12

043Health, P –12

044Physical Education, PK–12

045Home Economics, PK–12

047Technology Education, PK–12

049Music, PK–12

055Partially Sighted, PK–12

057Deaf and Hard of Hearing, PK–12

059Blind, PK–12

062School Library Media Specialist

072 School Nurse-Teacher

073School Dental Hygienist-Teacher

089Marketing Education, 7–12

101World Language Instructor, Elementary

102Remedial Reading & Remedial Language Arts, 1–12

104Cooperative Work Education/Diversified Occupations

110Unique Subject Area

111Teaching English to Speakers of Other Languages (TESOL), PK–12

112Integrated Early Childhood/Special Ed., Birth – Kindergarten

113Integrated Early Childhood/Special Ed., Nursery -K–Elem. 1–3

165Comprehensive Special Education, K–12

215English, Middle School

226History & Social Studies, Middle School

229Mathematics, Middle School

230Biology, Middle School

231Chemistry, Middle School

232Physics, Middle School

233Earth Science, Middle School

234General Science, Middle School

235Integrated Science, Middle School

305Elementary, 1 – 6

317Portuguese, 7–12

318Mandarin Chinese, 7–12

483Dance, Pre-K–12

485Theatre and Drama, Pre-K–12

511Montesori, Elementary, 1–6

512Montesori, Primary, Birth to Kindergarten

826Vocational Department Head: Trade Technology

Administrative Endorsements		Adult Education Endorsements
		Adult Education Endorsements
085	School Business Administrator	088	Non-English Speaking Adults
092	Intermediate Administration or Supervision	106	High School Credit Diploma Program
093	Superintendent of Schools	107	External Diploma Program/Noncredit Mandated Programs
097	Reading and Language Arts Consultant
105	Department Chairperson

Special Services Endorsements
061	Speech and Language Pathologist	Vocational Endorsements
068	School Counselor	082	Vocational Technical Administrator
070	School Psychologist	090	Occupational Subject, Vocational Technical Schools
071	School Social Worker	091	Trade-Related Subjects, Vocational Technical Schools
268	School Marriage and Family Therapist	098	Trade & Industrial Occupations – Comprehensive High School
		103	Health Occupations – Comprehensive High School
		108	Practical Nurse Education Instruction

NOTE: Bilingual codes are not provided. Check appropriate box on application to request a bilingual endorsement.

PAGE 4

	ED 177	CONNECTICUT STATE DEPARTMENT OF EDUCATION
	REV. 9/20	Bureau of Educator Standards and Certification
	C.G.S. 10-145	P.O. Box 150471
	C.G.S. 10-145d	P.O. Box 150471
	C.G.S. 10-145d	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	Hartford, CT 06115-0471
	Regs. 10-145d-421, 422	www.ct.gov/sde/cert
		www.ct.gov/sde/cert

APPLICATION FOR DURATIONAL SHORTAGE AREA PERMIT (DSAP)

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

LAST NAME

FIRST NAME

˗ ˗

SOCIAL SECURITY NUMBER

ADDRESS (Street ONLY, no P.O. Box)

CITY

ZIP CODE

MIGENDER ˗ ˗

BIRTH DATE (Month-Day-Year) - Required

APT. #

(State)

FORMER LAST NAME(S)

PHONE

(Home/Cell)

Race/Ethnicity

(Work)

(Optional)

E-MAIL ADDRESS

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

YES

Have you been dismissed for cause from any position?

YES

Have you ever surrendered a professional certificate, 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?

1.Native American

2.Asian/Pacific Islander

3.Black

4.White

5.Hispanic

Pursuant to Connecticut General Statutes Section 10-221d, the State Board of Education must submit, periodically, a database of applicants for an initial issuance of a certificate, 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 certificate, 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 certificate, 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 official copies of court or administrative record(s), including disposition of each case.

Original Signatures Must Be On The Form Submitted

PAGE 1

ED 177

PART II: EDUCATIONAL BACKGROUND

List the names of the colleges or universities attended:

		Dates Attended	Major Field	Degree
Name of Institution	State/Country	From To	of Study	Awarded

PART III: CANDIDATE ATTESTATION

I certify that the information provided by me on this application and any accompanying documents contains no material misrepresentations, falsifications 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 verified and that any material misrepresentation, falsification or omission may result in the denial or revocation of my 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.

I Agree

SIGNATURE OF CANDIDATE:

DATE:

PART IV:

SCHOOL OR DISTRICT REQUEST FOR FIRST ISSUANCE OF THE DSAP

1.No certified candidate suitable for the position is available to serve in the subject(s) requested. I hereby request issuance of a DSAP for the applicant to serve as:

		Endorsement Required for Position
Specific Subject or Field to be Taught
	Grade Level

(see endorsement code list)

Check box if bilingual endorsement is sought in above subject.

Indicate language of the bilingual endorsement

2.List the steps that have been taken to secure a suitable certified person, including dates and specific locations of newspaper, media, vacancy notices, university postings, Internet job positions, teacher agency listings, etc. Please note that advertisements must be within 6 months.

a. Total number of candidates who applied for this position:

b. Number of candidates who hold appropriate Connecticut certification:

c. Number of candidates interviewed for this position:

d.Reason(s) why certified candidates, if any, were not hired. Include any circumstances and conditions which make this position difficult to fill:

3.Indicate why a DSAP is requested for this particular uncertified applicant.

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

PAGE 2

ED 177

PART V: ATTESTATION AND SIGNATURE OF EMPLOYING AGENT

The candidate named on this application:

Has been or will be entered into the Connecticut State Department of Education (CSDE) electronic staff file Educator Data System (EDS), with an assignment code appropriate to the endorsement sought under the DSAP.

Will be given special attention in the form of supervision and other assistance, as appropriate.

Signature of Superintendent, Executive Director or Designee
		Date
attesting to accuracy of information
(Original Signature: No Signature Stamps Accepted)
Typed or Printed Name of Person Signing Above
		Title
School or District		Telephone
City	State Zip Code
		E-mail Address – School or District Contact
		Person

Fax

PAGE 3

ED 177

PART VI:

SCHOOL OR DISTRICT REQUEST FOR REISSUANCE OF THE DSAP

1. I hereby request reissuance of a DSAP for the applicant to serve as:

Specific Subject or Field to be Taught Grade Level Endorsement Required for Position

(see endorsement code list)

Check box if bilingual endorsement is sought in above subject.

Indicate language of the bilingual endorsement

PART VII: ATTESTATION AND SIGNATURE OF SCHOOL OR DISTRICT

The candidate named on this application:

Has completed a minimum of nine semester hours of credit in the subject or field requested during the validity period of the previous DSAP.

Has or will be entered into the CSDE Educator Data System (EDS), with an assignment code appropriate to the endorsement sought under the DSAP.

Has successfully served under the previously issued DSAP.

Will be given special attention in the form of supervision and other assistance, as appropriate.

An ED 177 Attachment is being submitted, if enrollment in a program is required for the endorsement.

Signature of Superintendent, Executive Director or Designee		Date
attesting to accuracy of information
(Original Signature: No Signature Stamps Accepted)
Typed or Printed Name of Person Signing Above
			Title
School or District		Telephone
City	State Zip Code
		E-mail Address – School or District Contact
			Person

Fax

PAGE 4

ED 177 – Attachment

REV. 9/20

CONNECTICUT STATE DEPARTMENT OF EDUCATION

Bureau of Educator Standards and Certification

P.O. Box 150471

Hartford, CT 06115-0471

www.ct.gov/sde/cert

EVIDENCE OF ENROLLMENT IN AN APPROVED EDUCATOR PREPARATION PROGRAM

NOTE: This ED 177 Attachment need not be completed if the candidate holds a valid Connecticut teaching certificate and is completing course work toward a cross endorsement (except for endorsements 102, 112, or 113).

PART A: Verification of Employment (this part must be completed by the employing agent)

Candidate’s Last Name	First Name		MI		Social Security Number
Position/Subject or Field
Position/Subject or Field		Grade Level		Endorsement Required for Position

(see endorsement code list)

Check box if bilingual endorsement is sought in above subject.

Indicate language for the bilingual endorsement

The candidate named above is being considered for a position which requires the completion of course work under a Durational Shortage Area Permit (DSAP).

Signature of Superintendent, Executive Director or Designee			Date
(Original Signature: No Signature Stamp Accepted)
Typed or Printed Name of Person Signing Above			Title
School or District			Telephone
City	State	Zip Code	E-mail Address – School or Disrict Contact Person

PAGE 5

ED 177 – Attachment (continued)

Name of Applicant:

PART B: Evidence of Enrollment or Application to an Approved Planned Educator Preparation Program

Evidence of Enrollment for Admission to an Approved Planned Educator Preparation Program

The above-named candidate is currently enrolled in or has applied and been accepted for admission to a approved planned program leading toward the institution’s recommendation for certification in:

Position/Subject or Field

Grade Level

Date of Enrollment or Date of Acceptance into the Program

Total number of semester hours of credit required to complete this certification program:

Number of semester hours of credit the candidate has already completed:

PART C: Attestation and Signature of the Certification Officer or the Academic Director of the Alternate Route to Certification (ARC) Program

Signature of Certification Officer or			Date
Academic Director of the ARC Program
Typed or Printed Name of Person Signing Above
				Title
Educator Preparation Provider (College, University, ARC)			Telephone
City	State	Zip Code
			E-mail Address

Mail Completed Form To:

CONNECTICUT STATE DEPARTMENT OF EDUCATION

Bureau of Educator Standards and Certification

P.O. Box 150471

Hartford, CT 06115-0471

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

PAGE 6

How to Edit Connecticut Ed 177 Form Online for Free

You could complete ed177 form easily with our PDFinity® PDF editor. To have our tool on the forefront of practicality, we work to integrate user-driven capabilities and improvements regularly. We're at all times grateful for any suggestions - assist us with remolding PDF editing. This is what you'd have to do to begin:

Step 1: Click the "Get Form" button above. It is going to open our pdf editor so that you can start filling out your form.

Step 2: Using this advanced PDF file editor, you may do more than just fill in blank fields. Express yourself and make your documents seem high-quality with custom textual content added in, or tweak the file's original input to perfection - all that supported by an ability to incorporate stunning pictures and sign the document off.

Completing this form usually requires attention to detail. Ensure all mandatory fields are filled in accurately.

1. When submitting the ed177 form, ensure to incorporate all of the important fields in the corresponding area. This will help to expedite the work, making it possible for your information to be handled fast and accurately.

Stage # 1 in submitting connecticut dsap

2. Once your current task is complete, take the next step – fill out all of these fields - CANDIDATE, a Complete Parts I II and III of, b Attach official transcripts, previous DSAP in the subject for, SCHOOL OR DISTRICT OFFICIAL, The application form ED and, a Complete Parts VI and VII of the, b Complete the Evidence of, preparation program or the, EDUCATOR PREPARATION PROVIDER, a Complete the Evidence of, and be completed if the candidate with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

a Complete Parts I II and III of, a Complete the Evidence of, and be completed if the candidate inside connecticut dsap

In terms of a Complete Parts I II and III of and a Complete the Evidence of, be certain that you review things in this current part. Both these could be the most important fields in the PDF.

3. This step is generally simple - fill in all the fields in PART I PERSONAL INFORMATION Print, LAST NAME, FIRST NAME, SOCIAL SECURITY NUMBER, ADDRESS Street ONLY no PO Box, CITY, ZIP CODE, PHONE, HomeCell, GENDER, BIRTH DATE MonthDayYear Required, APT, FORMER LAST NAMES, State, and RaceEthnicity to finish this part.

Stage number 3 for submitting connecticut dsap

4. The following subsection requires your involvement in the subsequent parts: Work, EMAIL ADDRESS, Optional, Native American AsianPacific, Have you ever been convicted of, Have you been dismissed for cause, Have you ever surrendered a, including but not limited to an, YES, YES, YES, Pursuant to Connecticut General, and NOTE If you answer YES to any of. Be sure that you fill in all of the required information to move further.

Learn how to complete connecticut dsap stage 4

5. This document needs to be finished by dealing with this segment. Below you will find an extensive listing of form fields that need appropriate details for your form usage to be accomplished: Name of Institution, StateCountry, From To, of Study, Dates Attended, Major Field, Degree Awarded, PART III CANDIDATE ATTESTATION I, By checking the I Agree box you, I Agree SIGNATURE OF CANDIDATE, and DATE.

The best ways to fill out connecticut dsap step 5

Step 3: Once you've looked over the information you given, click "Done" to complete your FormsPal process. Try a free trial subscription at FormsPal and gain immediate access to ed177 form - with all adjustments kept and available inside your personal account page. When using FormsPal, it is simple to complete documents without being concerned about personal information breaches or entries being distributed. Our secure software helps to ensure that your personal data is stored safely.

Connecticut Ed 177 Form – Fill Out and Use This PDF

Connecticut Ed 177 Form PDF Details

Form Preview Example

How to Edit Connecticut Ed 177 Form Online for Free

Connecticut Ed 177 Form isn’t the one you’re looking for?

Related Documents