Application For Temporary Emergency Coaching Permit (Page 4 of 4) in pdf

Application For Temporary Emergency Coaching Permit Page 4

ED 186

CONNECTICUT STATE DEPARTMENT OF EDUCATION

REV. 3/12

Bureau of Educator Standards and Certification

C.G.S. 10-145

P.O. Box 150471 – Room 243

C.G.S. 10-145d

C.G.S. 10-149

Hartford, CT 06115-0471

C.G.S. 10-149b

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.

Application For Temporary Emergency Coaching Permit Page 4