Childcare Assistance Application 2017- 2018 Central Piedmont Community College

Childcare Assistance Application 2017- 2018 Central Piedmont Community College Deadline for the Fall 2017 Semester Applications: July 15, 2017

Please carefully read the information on this page before completing the application. If you have any questions, please call the Family Resource Center at 704-330-6246. This program has been funded by the State of North Carolina to assist community college students with their childcare needs. At CPCC, the Childcare Assistance Committee reviews and evaluates applications and recommends recipients. Funds are administered by the Family Resource Center. PLEASE NOTE: Employees of CPCC are not eligible to apply for childcare assistance through this program. Work study is considered a form of financial aid, and recipients of this assistance may apply.

Funding: In past years, the college has generally received an amount of money which could assist about 20 students each year. Students accepted into this program have typically been awarded assistance with 70% of their childcare costs, and the remainder of the cost was the student’s responsibility.

Minimum Standards for Applying: In order to be considered for the childcare assistance program, new applicants must

 Have successfully completed a minimum of 12 credit hours at CPCC  Have a minimum of a 2.0 GPA (both cumulatively and for the previous semesters)  Have enrolled for the semester for which they are applying - for a minimum of 6 credit hours of college-level, curriculum classes, - which are not on-line and which meet during the time of day that they are requesting assistance Criteria used in Selecting New Recipients: In making its recommendations, the Childcare Assistance Committee evaluates applications based on the following standards:  Financial need  Strength of academic record  Progress toward completion of program/degree  Class schedule and course load In addition, students may write a letter explaining any special needs or circumstances they would like for the selection committee to also consider. Selection Process: After the application deadline, the Committee meets to evaluate applications. Students already participating in the program and in good standing are awarded first when childcare assistance funds are available. The committee ranks applications and makes recommendations at their meeting. However, awards cannot be determined until information about the programs’ funding status is available for the upcoming semester. In past years, notification about funding has sometimes not been made until after the beginning of the semester.

In order for this application to be considered, the following 3 documents must be included. If one of these documents is not available, a note explaining the reason should be substituted. The CPCC documents below can be found on “My College”. Please include:  Financial Aid Award Letter  Program Evaluation  Copy of birth certificates of all children for whom childcare is being requested

Name ______CPCC ID #______Last First

CPCC E-mail address______Last 4 digits of Social Security # ______

Home Phone #: ______Cell Phone # ______

Address______Street City State Zip Name of Employer ______Hours working per week ______

Are you (place an X by the one that applies): _____ Married _____ Single _____ Divorced - Date: ______Separated - Date: ______Widowed - Date: ______

Name of Spouse: ______Spouse’s Employer: ______Number of children in the household: ______Ages of children:______

______

CPCC Enrollment Status:

Are you currently enrolled at CPCC? _____If no, anticipated start date: ______How many hours have you completed here at CPCC? ______Transfer credits? ______How many hours are you currently taking? _____ How many hours do you plan to take each semester? _____ Name of Program: ______Have you been accepted into this program? _____ Anticipated Graduation Date: ______Please list the courses for which you plan to enroll or are enrolled for the upcoming semester:

______

Information about Financial Resources:

Have you completed the Free Application for Federal Student Aid (FAFSA)? ______

Have you received your award notification? ______If “yes,” is it attached? ______Federal Pell Grant: $ ______Federal Supplemental Educational Opportunity Grant: $ ______

Federal Work-Study: $ ______Scholarship: $ ______Any other financial aid: $______Have you applied to the county’s Childcare Resources program for assistance? ______If “yes”, note the status of your application: ______(If “no”, you can call 704-376-6697 to apply. Students who live outside Mecklenburg County should contact their Department of Social Services to learn more about county childcare programs.)

Please check each resource you are receiving assistance from: _____ AFDC _____ Food Stamps _____ Workforce/Jobs _____ Medicaid

_____ Child Support (If “yes,” how much per month? $______) _____ Public Housing

_____Veteran’s Benefits (If “yes,” how much per month? $______) ______Loans

List any additional aid you are receiving: ______

Information about Living Expenses:

Do you rent or own your place of residence? ______How much per month do you pay? $______

Do you have any other significant expenses per month? ______Please describe:______

______

Have there been significant changes in your income since last year? ______If so, why?:______

Information about Children Needing Care:

Please list the name and age of each of the children for whom you are requesting childcare assistance: Name Age Date of Birth Last 4 digits of Social Security #

______

Do the children listed live with you? ______If “no,” please explain ______Did you claim the listed children above on your federal tax returns? ______If “no,” please explain ______

Type of Childcare Assistance Needed:

# of children needing full time childcare? ______

# of children needing before school care? ______# of children needing after school care? ______

Each Child’s Childcare Needs:

1) Child’s name:______Check which type of care is needed: Full-time childcare? ______Before-school care?______After-school care?______Cost per week of this childcare: (Please estimate if you do not know.) ______If you know which childcare provider you would like to use, please list it: ______Is your child currently enrolled with this provider? ______Phone # of childcare provider: ______

If you are NOT using this provider, how is childcare currently being handled? ______

2) Child’s name: ______Check which type of care is needed: Full-time childcare? ______Before-school care?______After-school care?______Cost per week of this childcare: (Please estimate if you do not know.) ______If you know which childcare provider you would like to use, please list it: ______Is your child currently enrolled with this provider? ______Phone # of childcare provider: ______

If you are NOT using this provider, how is childcare currently being handled? ______

3) Child’s name: ______Check which type of care is needed: Full-time childcare? ______Before-school care?______After-school care?______Cost per week of this childcare: (Please estimate if you do not know.) ______If you know which childcare provider you would like to use, please list it: ______Is your child currently enrolled with this provider? ______Phone # of childcare provider: ______If you are NOT using this provider, how is childcare currently being handled? ______

In signing this application, I acknowledge that I am not an employee of CPCC, that I have read the guidelines on page one of these forms, and that the information I am submitting is accurate to the best of my knowledge. I understand that willfully providing any false information on this form will result in the immediate removal of my application for this assistance. I agree to allow committee members to contact faculty/staff regarding my academic progress as it relates to this application.

Signature: ______Date: ______

Please return this form to: the Family Resource Center in Overcash 254, Central Campus or mail it to: Family Resource Center/Student Life Central Piedmont Community College P.O. Box 35009 Charlotte, NC 28235-5009

NOTE: If you submit this application by mail, e-mail, or fax, or if you leave it in the Family Resource Center’s mail box in the Student Life office, please call the Family Resource Center at 704-330-6246 to confirm that it has been received by our staff. Revised April 19, 2017