Get Ed172a Fillable 2010-2025

The Ed172a Fillable form is an essential application for obtaining an initial educator certificate in Connecticut. This guide will provide clear instructions on how to complete the form accurately and effectively.

Follow the steps to fill out the Ed172a Fillable online completely and correctly.

1. Click ‘Get Form’ button to access the document and open it in your online editor.
2. Begin by filling out Part I: Personal Information. Use uppercase letters and blue ink for all entries. Carefully enter your last name, first name, gender, social security number, and birth date (formatted as Month-Day-Year) as required.
3. Complete your address information, including street, apartment number (if applicable), city, state, and zip code. It is also important to provide a contact number and an email address.
4. Indicate any former last names you have used, if applicable. This information may be relevant for background checks.
5. In the race/ethnicity section, select any applicable categories. This is optional and can be left blank if you prefer not to disclose.
6. Answer the questions regarding previous criminal convictions and professional credential actions honestly. If you answer “yes” to any questions, be prepared to attach a signed statement of explanation and related documentation.
7. Proceed to Part II: Applicant Request for Additional Endorsement(s) if applicable. Mark ‘yes’ if you are requesting additional endorsements, and fill out the corresponding endorsement codes.
8. In the affirmation section, read the applicant attestation carefully to ensure you understand the implications of your signature. Your original signature is required along with the date of signing.
9. If you are submitting this form, the local board of education must complete Part III. This part includes verification and attestation by the superintendent or their designee.
10. Finally, review all sections of the form carefully for accuracy. Once complete, you can save the changes, download a copy of the filled form, print it, or share it as needed.

Start filling out your Ed172a Fillable form online today to ensure you meet the requirements for your initial educator certificate.