Eligibility Requirements:
Must be the custodial parent of a child/children needing child care
Must be a current enrolled student at Southwest Tennessee Community College
Must be eligible to receive a Pell Grant (and have submitted a FAFSA for the current academic year)
Must be in good academic standing with a 2.0 or higher cumulative GPA (excluding first time college students)
Submission of short essay describing your need for the CCAMPIS assistance
Name
*
Banner ID#
*
Address
*
Contact #
*
Phone
Second contact #
Phone
Email Address
*
D.O.B.
*
mm/dd/yyyy
Gender
*
Male
Female
Ethnicity
*
Black
White
Hispanic
Asian
Other
Marital Status
*
Married
SIngle
Divorced
Widowed
Separated
Enrollment Status
*
Freshman (29hrs. or less)
Sophomore (30 hrs. or more)
What is your Major?
*
Your goal is to receive
*
2 Year Degree
Certificate
Enhancement
Expected Graduation Date
*
How long have you been working on your degree?
How many Semesters?
*
How many years?
*
# of credit hours to graduate
List child(ren)'s names and DOB
Are you Head of Household?
*
Yes
No
Living Status
*
Independent
With Parents
Are you currently receiving a Pell Grant?
*
Yes
No
By Checking this: I certify that the information on this application is true and complete. I authorize information regarding my scholarship application, academic record, and financial aid award info released to the Southwest Tennessee Community College Child Care Center CCAMPIS staff. I understand that the CCAMPIS staff may require additional documentation to verify the completion or accuracy of this application, and I agree to the release of such information and documentation.
*
By Checking this: I certify that the information on this application is true and complete. I authorize information regarding my scholarship application, academic record, and financial aid award info released to the Southwest Tennessee Community College Child Care Center CCAMPIS staff. I understand that the CCAMPIS staff may require additional documentation to verify the completion or accuracy of this application, and I agree to the release of such information and documentation.
*
*
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