↦

Fill Out Your Ed 186 Form

The ED 186 form is an application used to request a Temporary Emergency Coaching Permit in Connecticut. This permit allows individuals to coach in schools under specific conditions when certified educators are not available. To ensure a smooth application process, it is important to provide accurate information and required documentation.

If you're ready to begin your application, click the button below to fill out the form.

Launch Ed 186 Editor Now

Article Structure

The ED 186 form, utilized by aspiring coaches in Connecticut, plays a critical role in the application process for a Temporary Emergency Coaching Permit. This form captures essential personal details, including the applicant's name, contact information, and social security number, while also collecting demographic information. Acknowledging the importance of safety and preparedness, the application mandates the completion of specific certifications, such as First Aid and CPR, which must be current. Additional requirements include the submission of educational credentials, notably a high school diploma or transcript, alongside a completion certificate for concussion and head injury training, reflecting a commitment to the health and well-being of student-athletes. Furthermore, applicants may need to disclose prior criminal convictions or any adverse actions against their credentials, ensuring that only qualified individuals assume such pivotal roles. For those seeking renewal, proof of ongoing education and practical experience as a coach is also required, underscoring the emphasis on continuous professional development in coaching practices.

Ed 186 Example


ED 186	CONNECTICUT STATE DEPARTMENT OF EDUCATION
ED 186	CONNECTICUT STATE DEPARTMENT OF EDUCATION
REV. 7/19	Bureau of Educator Standards and Certification
C.G.S. 10-145	P.O. Box 150471
C.G.S. 10-145d	Hartford, CT 06115-0471
C.G.S. 10-149	Hartford, CT 06115-0471
C.G.S. 10-149b	www.ct.gov/sde/cert
Regs. 10-145d-424
	APPLICATION FOR TEMPORARY EMERGENCY COACHING PERMIT

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

LAST NAME

FIRST NAME

GENDER

SOCIAL SECURITY NUMBER

BIRTH DATE (Month-Day-Year) - Required

ADDRESS (Street)

Apt. #

(City)

(State)

FORMER LAST NAME(S)

(Zip Code)

PHONE

(Home)

Race/Ethnicity 1.

Native American

Asian/Pacific Islander

Black

(Work)

White

(Optional)

Hispanic

E-MAIL ADDRESS

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

YES

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

YES

3. 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?

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 use.

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 first aid course must have been completed with 1 year prior to the date of application. Please sign your first aid card and attach: (1) a photocopy of both the front and back of the first aid card, or (2) original certificate 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 certificate 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 official high school transcript to this application.

PART V: CONCUSSION AND HEAD INJURY TRAINING REQUIREMENT

Attach the original certificate 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;

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

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

PART VII: APPLICANT ATTESTATION

I have reviewed this application and affirm that the information provided by me on this application and any accompanying documents contains no material misrepresentations, falsifications or omissions and that all 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.

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 certified teacher possessing a coaching permit or noncertified 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			Date
(Original Signature: No Signature Stamps Accepted)

Type or Printed Name of Person Signing Above			Title
Employing Agent			Telephone
Street
Street			E-mail Address
City	State	Zip Code

PAGE 3

ED 186	CONNECTICUT STATE DEPARTMENT OF EDUCATION
REV. 7/19	Bureau of Educator Standards and Certification
C.G.S. 10-145	P.O. Box 150471
C.G.S. 10-145d	Hartford, CT 06115-0471
C.G.S. 10-149	Hartford, CT 06115-0471
C.G.S. 10-149b	www.ct.gov/sde/cert
Regs. 10-145d-424
	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 certificate 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 certificate 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 official high school transcript may be submitted in lieu of a copy of your diploma.

e. Attach the original certificate 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 Certification.

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 Certification.

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

Get Ed 186 PDF Form

Form Characteristics

Fact Name	Fact Detail
Form Title	ED 186 Application for Temporary Emergency Coaching Permit
Governing Body	Connecticut State Department of Education
Last Revision Date	Revised in July 2019
Governing Laws	Connecticut General Statutes Section 10-145, 10-145d, 10-149, 10-149b
Application Requirement	Completion of Standard First Aid and CPR courses within one year prior to the application date
Disclosure	Information provided is subject to the Freedom of Information Act
Criminal Background Check	State Police Bureau of Investigation will conduct a criminal history record check
High School Documentation	Must submit a copy of high school diploma or transcript
Signature Requirement	Original signature required on the application; no signature stamps accepted

Guidelines on Utilizing Ed 186

Filling out the Ed 186 form can seem daunting at first, but breaking it down into manageable steps makes the process much simpler. This form is essential for those seeking a Temporary Emergency Coaching Permit in Connecticut. With the right guidance, you can confidently provide the necessary information and supporting documentation to move forward in your coaching career.

Gather all necessary personal information, including your last name, first name, middle initial, gender, social security number, birth date, address, phone numbers, email address, and any former last names.
Decide on your race/ethnicity from the provided list and mark the appropriate option.
Answer the criminal background questions honestly. If you answer "YES" to any question, prepare a signed statement explaining the details.
Complete Part II by noting the name and completion date of the required First Aid course. Remember to sign your First Aid card as well.
In Part III, fill in the name and completion date of your CPR course, also ensuring you sign the CPR card prior to submitting.
For Part IV, attach a copy of your high school diploma or official transcript.
Complete Part V by attaching the original certificate for the concussion and head injury training requirement.
In Part VI, only complete this section if you seek a renewal of the coaching permit, providing proof of enrollment in or completion of an approved coaching course.
In Part VII, review your application for accuracy and completeness. Affirm your statements and check the "I Agree" box, then sign and date the application.
Finally, if applicable, proceed to Part VIII for the Employing Agent's attestation, ensuring all sections are completed and signed before submission.

Once you have completed the form, ensure all documents are attached as per the instructions mentioned. Then, gather the application package and return it to the appropriate school superintendent for processing. Following these steps will help ensure your application is complete and ready for review.

What You Should Know About This Form

What is the ED 186 form and what is its purpose?

The ED 186 form is an Application for a Temporary Emergency Coaching Permit issued by the Connecticut State Department of Education. Its primary purpose is to allow individuals to obtain a coaching permit in situations where certified teachers are unavailable for a specific coaching role. This form collects essential personal information, verifies the completion of required training courses, and ensures that the applicant meets necessary legal and professional criteria.

What are the requirements for completing the ED 186 form?

To successfully complete the ED 186 form, applicants must provide personal information, including their last name, first name, gender, social security number, and contact details. In addition, they need to confirm the completion of mandatory training courses in first aid, CPR, and concussion awareness. Attachments such as a high school diploma, first aid and CPR certificates, and the concussion training completion certificate must be included. Providing clear and truthful answers to questions about prior convictions or professional conduct is also crucial, as any affirmative responses require additional explanation.

How does the application process work?

Once you have filled out the ED 186 form and gathered the required documents, submit everything to the superintendent of schools in your district. The employing agent, typically the superintendent or their designee, must complete a section confirming the need for the permit. They will evaluate your qualifications and determine if you can be supervised appropriately during your coaching role. It is essential to ensure that all parts of the application are complete to avoid delays in processing.

What happens if I have a criminal record or prior professional misconduct?

If you answer “YES” to any questions regarding criminal convictions or past employment issues, you must include a signed explanation detailing each incident. Original court documents or administrative records relating to the incidents should also be attached. This information will be reviewed thoroughly, and any misrepresentation or omission can lead to denial or revocation of your coaching permit, so honesty is crucial.

Can I renew my Temporary Emergency Coaching Permit using the ED 186 form?

Yes, the ED 186 form includes a section specifically for renewing your Temporary Emergency Coaching Permit. To renew, provide proof of enrollment in an approved coaching course, an official transcript verifying completed coursework, or evidence of professional development hours in coaching. All renewal applications must also go through the employing agent for their confirmation and approval before being submitted to the Bureau of Educator Standards and Certification.

Common mistakes

Applying for a Temporary Emergency Coaching Permit using the ED 186 form is an important process that requires careful attention. Mistakes can lead to delays or even denial of the permit. One common mistake is not using blue ink and upper case letters for personal information. This requirement is explicitly stated, yet many applicants overlook it. Filling out the form in black ink or using lowercase letters can render the application invalid.

Another frequent error involves answering the questions about criminal history and professional conduct. If an applicant answers "YES" to any of these questions, they must include a signed statement explaining the circumstances. Failing to provide this additional information can lead to the application being rejected. It is crucial to give a complete and honest account of past incidents, as transparency is key.

Inadequately completing the required sections can also cause issues. For instance, applicants often forget to attach important documents, like the high school diploma or CPR certification. Each section of the form has specific documentation requirements. Not providing the proper attachments can result in a longer processing time or a request to resubmit the application with the needed materials.

Lastly, some applicants neglect the attestation part of the form. This section affirms that the information provided is true and complete. Skipping this step or failing to sign it can create further complications. Ensuring every part of the application is filled out thoroughly, and double-checking all requirements is essential for a smooth submission process.

Documents used along the form

The ED 186 form is an essential document for applicants seeking a Temporary Emergency Coaching Permit in Connecticut. Along with this form, several other documents and forms are typically required to complete the application or renewal process. Each of these documents serves a specific purpose to ensure compliance with state regulations and maintain the integrity of coaching standards.

First Aid Certification: A verification of successful completion of a first aid course within the last year. This certification must accompany the ED 186 form and can be provided as a photocopy or original certificate.
CPR Certification: Similar to the first aid certificate, this document shows that the applicant has completed a CPR course within one year prior to applying. It also needs to be signed and attached to the application.
High School Diploma or Transcript: A copy of the high school diploma or an official transcript is required to demonstrate educational qualifications.
Concussion and Head Injury Training Certificate: This certificate proves that the applicant has completed the required training related to concussions and head injuries as mandated by Connecticut's Coaching Education Program.
Proof of Enrollment in a Coaching Course: If the applicant is renewing the permit, evidence of enrollment in an approved coaching course must be submitted to validate ongoing education.
Official Transcript for Coaching Course Completion: This is necessary for renewal as well, proving that the applicant has completed at least two semester hours in an approved coaching course.
Verification of Instruction Hours: For renewal requests, applicants must provide verification of completing 30 clock hours of instruction in an approved coaching course.
Signed Statement of Explanation: If the applicant answers "yes" to specific questions regarding prior convictions or disciplinary actions, a signed statement explaining the circumstances must be attached.
Employing Agent Attestation: This document must be signed by the superintendent or designee, confirming the eligibility of the applicant for the emergency coaching permit.

Submitting all required forms and documents, including the ED 186 form and accompanying certifications, is crucial for a smooth application process. Ensuring that every document is complete and accurate will help applicants avoid delays or complications in obtaining their Temporary Emergency Coaching Permit.

Similar forms

The ED 186 form is essential for obtaining a Temporary Emergency Coaching Permit in Connecticut. Several other documents serve similar purposes in verifying qualifications, background checks, or certifications. Below are six documents that share similarities with the ED 186 form:

ED 101 Application for Initial Certification: Like the ED 186, this document collects personal information, including background checks and educational qualifications. It also requires applicants to disclose criminal history and previous employment details.
CPR Certification Card: This crucial document confirms the completion of CPR training. The ED 186 form also requires a CPR certificate, thereby emphasizing the importance of safety training in coaching.
First Aid Certification Card: Similar to CPR certification, the First Aid card verifies training completion, which is necessary for the ED 186. Both are aimed at ensuring the safety and emergency preparedness of coaches on the field.
Child Abuse/Neglect Registry Check Form: This document ensures that applicants have no history that would make them unsuitable for working with minors. The ED 186 requires a similar check to safeguard student welfare.
Coaching Course Completion Certificate: This certificate attests to the completion of required coaching education. The ED 186 form specifically asks for proof of course enrollment or completion, highlighting the importance of professional training in coaching roles.
Public School Employment Application: This application is commonly required by school districts. It shares similarities with the ED 186 in gathering personal details and previous employment history, ensuring that candidates meet necessary criteria.

Dos and Don'ts

When filling out the ED 186 form for a Temporary Emergency Coaching Permit in Connecticut, it's essential to follow certain practices to ensure a smooth application process. Here are five important dos and don’ts:

Do print all information using blue ink and in uppercase letters.
Don't leave any sections blank; ensure all required fields are completed.
Do attach required documents, such as first aid and CPR certificates, to support your application.
Don't forget to sign the application form; an original signature is mandatory.
Do review your application for accuracy before submission to avoid potential delays.

Following these guidelines can significantly improve your chances of a successful application. Prepare well and ensure that every detail is accounted for. Good luck!

Misconceptions

Misconceptions about the ED 186 form can lead to confusion for those looking to obtain a coaching permit. Here are five common misconceptions explained:

It is a permanent coaching permit. The ED 186 form is for a Temporary Emergency Coaching Permit. It does not grant permanent coaching credentials. Coaches must renew their permits periodically or pursue full certification.
First aid and CPR requirements can be completed after submitting the form. Both first aid and CPR courses must be completed within a year before applying. Documentation proving completion must accompany the application.
Only teachers can apply for this permit. Non-certified individuals can also apply for a Temporary Emergency Coaching Permit if they meet the necessary requirements. This opens opportunities for qualified coaches from diverse backgrounds.
Criminal history checks are optional. All applicants must undergo a criminal history record check. This requirement is mandated to ensure the safety of students and the integrity of the coaching program.
Once submitted, the application cannot be corrected. If mistakes are discovered after submission, applicants can provide corrected information or additional documentation as needed. Transparency is crucial in the application process.

Understanding these misconceptions can help applicants navigate the application process more effectively, ensuring they meet all requirements for the Temporary Emergency Coaching Permit.

Key takeaways

Here are some key takeaways about filling out and using the ED 186 form:

Accurate Information: Ensure that all personal information is complete and accurate, as incorrect information may delay the application process.
Uppercase Required: Fill out the form in uppercase letters using blue ink to maintain clarity and consistency.
Attachments are Crucial: Include all required documents, such as your high school diploma and certificates for first aid and CPR, to avoid any issues with your application.
Criminal History Disclosure: Be prepared to answer questions regarding any past criminal record or professional license issues; a signed explanation is necessary if any "YES" answers arise.
First Aid & CPR Courses: Complete both first aid and CPR courses within one year prior to submitting your application, and provide appropriate documentation.
Concussion Training Required: Attach the original certificate of completion for concussion and head injury training to the application. This is mandatory for coaching permits in Connecticut.
Employer Supervision: A section of the form requires attestation from your employing agent, confirming they understand the temporary nature of the permit and the supervision arrangements.
Renewals are Different: For renewals, additional documentation is required. Ensure that you provide proof of coursework or instruction hours completed in an approved coaching course.
Original Signatures Needed: Signatures must be original; do not use a signature stamp. This applies to both the applicant's and the employing agent's sections.

These points will help navigate the application process for the Temporary Emergency Coaching Permit effectively.

Browse Other Templates

Indiana Vehicle Title - Submitting this form correctly facilitates smooth processing at the BMV.

Ncdes - Inaccurate or insufficient records could result in denial or overpayment of benefits.