Ct Temporary Coaching Permit Details

Form Ed 186 is a document that all postsecondary institutions in Alberta must complete for each international student they enrol. This form helps ensure that postsecondary institutions are meeting their obligations under the Immigration and Refugee Protection Act (IRPA) and associated regulations. Completing Form Ed 186 is important for both postsecondary institutions and international students, as it helps to ensure a positive experience for everyone involved. In this blog post, we will discuss what Form Ed 186 is, why it is important, and how to complete it.

These are some information regarding form ed 186. Our advice is that you look at this info before you begin filling out the form.

QuestionAnswer
Form NameForm Ed 186
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesct coaching cert, state of ct emergency coaching permit form 186 online, ct emergency coaching permit, state of ct ed 186

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ED 186

CONNECTICUT STATE DEPARTMENT OF EDUCATION

REV. 3/12

Bureau of Educator Standards and Certiication

C.G.S. 10-145

P.O. Box 150471 – Room 243

C.G.S. 10-145d

Hartford, CT 06115-0471

C.G.S. 10-149

C.G.S. 10-149b

 

Regs. 10-145d-424

www.ct.gov/sde

 

APPLICATION FOR TEMPORARY EMERGENCY COACHING PERMIT

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

LAST NAME

FIRST NAME

– –

SOCIAL SECURITY NUMBER

ADDRESS (Street)

(City)

(State)

(Zip Code)

PHONE

(Home/Cell)

E-MAIL ADDRESS

MI

 

GENDER (M/F)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTH DATE (Month-Day-Year)Required

(Apt #)

FORMER LAST NAME(S)

Race/Ethnicity

1.

Native American

 

 

 

2.

Asian/Paciic Islander

 

 

 

 

 

 

3.

Black

(Optional)

4.

White

 

 

 

5.

Hispanic

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

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

3.Have you ever surrendered a professional certiicate, 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?

YES YES YES

NO NO NO

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 186

PART II: COMPLETION OF REQUIRED FIRST AID COURSE

The irst aid course must have been completed within 1 year 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

The CPR course must have been completed within 1 year prior to the date of application. Please sign your 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: RENEWAL OF COACHING PERMIT

Complete this section ONLY if you are requesting renewal of the Temporary Emergency Coaching Permit.

1. Provide proof of enrollment in an approved coaching course;

OR

2. Attach an oficial transcript verifying the completion of at least two (2) semester hours of credit in an approved coaching course;

OR

3. Provide veriication of completion of 30 clock hours of instruction in an approved coaching course.

PART VII: 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 186

PART VIII: EMPLOYING AGENT ATTESTATION

A. Check one:

Initial Permit

Renewal

I am requesting issuance of a Temporary Emergency Coaching Permit for the _________________ school year. This request is made on

the basis of my determination that no certiied teacher possessing a coaching permit or noncertiied individual possessing a coaching permit

is available for the position and that the applicant meets all requirements for issuance of the permit. The applicant will be supervised and assisted, as appropriate, by regular observation, guidance and evaluation of performance.

B.For RENEWAL request, also complete this section:

Renewal of the Temporary Emergency Coaching Permit is requested for the following school year:____________________________

The applicant has served successfully as a coach during the school year:__________________________________

C.Signature of Superintendents or Designee required for all requests:

Signature of Superintendent, Executive Director or Designee

(Original Signature: No Signature Stamps Accepted)

Typed or Printed Name of Person Signing Above

Employing Agent

Street

Date

Title

Telephone

E-mail Address

City,

State

Zip Code

Original Signature Must Be On Form Submitted

PAGE 3

ED 186 CONNECTICUT STATE DEPARTMENT OF EDUCATION

REV. 3/12

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-424

P.O. Box 150471 – Room 243

Hartford, CT 06115-0471

www.ct.gov/sde

INSTRUCTIONS TO APPLICATION FOR

TEMPORARY EMERGENCY COACHING PERMIT

Applicant:

For the ISSUANCE of the Temporary Emergency Coaching Permit you must complete and submit the following:

a. Complete Parts I through V, and Part VII.

b. Attach a photocopy of your Standard First Aid card, or original certiicate of completion, verifying the successful completion of the Standard First Aid course within one year prior to the date of application. 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, verifying the successful completion of the CPR course within one year prior to the date of application. Please remember to sign your CPR card prior to photocopying.

d. Attach a photocopy of your high school diploma or its equivalent. Your oficial high school transcript may be

submitted in lieu of a copy of your diploma.

e. Attach the original certiicate of completion of the concussion and head injury training requirement (Module 15) from the Connecticut Coaching Education Program (CCEP).

f. Return completed application to the superintendent of schools.

For the RENEWAL of the Temporary Emergency Coaching Permit, please complete Parts I, through III, V, through VII.

Employing Agent:

For the ISSUANCE of the Temporary Emergency Coaching Permit:

a. Complete Part VIII, sections A and C. Please mail application and supporting documentation to the Bureau of

Educator Standards and Certiication.

For the RENEWAL of the Temporary Emergency Coaching Permit:

b. Complete Part VIII, sections A, B, and C. Please mail application and supporting documentation to the Bureau of Educator Standards and Certiication.

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

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