T.E.A.C.H. Early Childhood North Carolina Early Childhood ...

T.E.A.C.H. Early Childhood North Carolina Early Childhood Administration Credential Scholarship Program Application for Child Care Center Directors/Owners Date

Social Security #

Name Address City, State, Zip County Phone Number

Home: (

)

Work: (

)

Email Date of Birth

(mm/dd/yyyy)

Gender Employment Status What is your current job title?  Teacher

 Administrator

 Non-Teaching Professional Staff

 Assistant Teacher

 Family Based Professional

 Non-Teaching Support Staff

What age groups do you teach? (please check all that apply)  Infants (0-12 Months)

 Preschool (37 Months – PreK)

 Toddler (13-36 Months)

 School Age

Is your center a NC Pre-K site?

 Yes

 No

Are you a teacher in a NC Pre-K classroom?

 Yes

 No

How long have you worked in the field of early

 Less than 2 Years

 6-10 Years

childhood?

 2-5 Years

 10+ Years

How many children are in your classroom or child care home? How many hours per week do you work? How many months per year do you work? Beginning date of employment at current facility? (mm/dd/yyyy) What is your current hourly salary?

2 Ethnicity Are you of Hispanic, Latino or Spanish origin?  No  Yes, Mexican, Mexican American, Chicano  Yes, Puerto Rican Do you consider yourself….?  White  Black, African Am. Or Negro  American Indian or Alaska Native  Asian Indian  Japanese  Native Hawaiian

     

 Yes, Cuban  Other Hispanic, Latino or Spanish

Chinese Korean Guamanian or Chamorro Filipino Vietnamese Samoan

 Other Asian:  Other Pacific Islanders:  Other race:

How did you hear about the T.E.A.C.H. Early Childhood® Project?  Presentation  College  Workshop  My Center Director  Website  Mailing  CCR&R Agency  T.E.A.C.H. Recipient  Other (please specify): _________________ Please check the box that best describes your educational history No high school diploma  Bachelor Degree   High school diploma/GED (Major: _____________________)  Masters  1-year certificate  Associate Degree (Major: __________________) (Major: _____________________)  Doctorate List all EARLY CHILDHOOD courses and ADMINISTRATION courses you have taken – attach additional page if needed

How many credit hours of early childhood coursework must you take to be eligible for the Administration Credential? Which Administration courses must you take to be eligible for the Administration Credential?  Early Childhood Administration I (EDU 261 – 2 semester credit hours)  Early Childhood Administration II (EDU 262 – 3 semester credit hours) When would you like your scholarship to begin? (circle one) FALL SPRING SUMMER ___________ (year) Which Community College would you like to attend? ______________________________________

Return This Application with Verification of Income to: T.E.A.C.H. Early Childhood® Project P.O. Box 231, Chapel Hill, NC 27514 or fax (919) 967-7040 If you have any questions, please call (919) 967-3272 www.childcareservices.org

3 Center Participation Agreement This agreement must be completed by the center owner or board chairperson. The T.E.A.C.H. Early Childhood Administration Credential Scholarship offered through Child Care Services Association requires the participation of each scholarship recipient’s employing child care center. In the event that (Applicant Name) ____________________ is awarded a scholarship, I understand that (Center Name) ________________________ agrees to participate in one of the following ways. (Please check one to indicate which applicable option you prefer) Director is employee of center. Model One – Option 1 Pay 10% of the cost of books and 10% of the tuition for courses associated with attaining the Administration Credential, up to a maximum of 12 credit hours Award a $150 bonus to the scholarship employee upon completion of the Administration Credential (Director commits to one year of employment in sponsoring center upon completion of scholarship contract) Director is employee of center. Model One – Option 2 Pay 10% of the cost of books and 10% of the tuition for courses associated with attaining the Administration Credential, up to a maximum of 12 credit hours No center bonus is associated with this option (Director commits to one year of employment in early childhood field, not necessarily in the sponsoring center) Director is also owner of center. Model Two Pay 20% of the cost of books and 20% of tuition for courses associated with attaining the Administration Credential, up to a maximum of 12 credit hours. (Director commits to one year of employment in the early childhood field upon completion of the scholarship contract.) Please Print name of chairperson/owner Signature of chairperson/owner Program License or Registration Number Center Name Center Address (city, state, zip, county) Email Address Tax ID Number Please check all forms of funding your facility receives  Head Start  State PreK  Early Head Start  Title I  State Head Start  IDEA

 State Subsidies: Contracts  State Subsidies: Vouchers

For Head Start or Multi-Site Programs Is this child care program owned or managed by another organization? If yes, give the parent company name/address:

 YES

FOR ALL PROGRAMS Number of children served Center Auspice: Center Star Rating: Is your Center accredited: If yes by whom?

 Profit 1 2  YES

 Nonprofit 3 4  NO

 No

 Head Start 5  GS110


4 Statement of Income Job #1 Employer _______________________________________________________ Hours/Week ___________________ Earnings _________________ per _____________ Job #2 Employer _______________________________________________________ Hours/Week ____________________Earnings _________________ per _____________ Have you applied for any other financial aid (such as Pell Grants, Smart Start Grants or student loans)?  YES  NO Source of financial aid #1 _____________________________Date of application ___________ Application Status:  AWARDED  DENIED  PENDING Source of financial aid #2 _____________________________Date of application ___________ Application Status:  AWARDED  DENIED  PENDING YOUR TOTAL INCOME $____________________________ YOUR TOTAL FAMILY INCOME (your spouse included) $_______________________

STATEMENT & SIGNATURE OF APPLICANT I, _________________________(applicant’s name), attest that the information provided on this application and the supporting documentation is true to the best of my knowledge. I understand that falsifying application information or documentation or the failure to comply with documentation requirements may result in the inability to be a participant on this program. If my participation is terminated due to my failure to comply with documentation requirements, I understand that my employer may be notified along with the program funder. If for any reason the scholarship money is issued incorrectly as a result of false information provided by me, I acknowledge that I will be required to reimburse the T.E.A.C.H. Early Childhood® Project for the monetary support that was received in error. ________________________________________ Signature of Applicant

____________________ Date

PLEASE ATTACH A COPY OF YOUR MOST RECENT PAY STUB HERE Application Checklist  Application Completed  Signed Participation Agreement

 Verification of income  Statement of income


EARLY CHILDHOOD ADMINISTRATION CREDENTIAL SCHOLARSHIP PROGRAM T.E.A.C.H. EARLY CHILDHOOD® Child Care Services Association, Inc. The Early Childhood Administration Credential Scholarship Program consists of two scholarship models: Model One provides two scholarship options for directors who are employees of their sponsoring center; Model Two provides a scholarship for directors who are also owners of their sponsoring center. This information page describes application and program requirements for all Administration Credential Scholarship candidates, as well as additional requirements specific to each model.

GENERAL CANDIDATE REQUIREMENTS To receive a T.E.A.C.H. Scholarship for participation in the Early Childhood Administration Credential Scholarship Program, a Candidate must: A.

Currently hold a position as director in a licensed childcare program, working not less than 30 hours per week;

B.

Enroll in a maximum of 12 semester credit hours of early childhood and/or early childhood administration curriculum coursework during the two-year scholarship contract period, at a Community College with an Early Childhood curriculum program;

C.

Attend classes regularly;

D.

Complete all assigned course work and successfully pass each course with a grade of “C” or better;

E.

Submit grade reports to CCSA after each semester of coursework;

F.

Submit tuition and book receipts each semester to CCSA on a completed Form B to receive reimbursement and travel stipend;

G.

Notify CCSA of additional sources of financial aid.

ADDITIONAL REQUIREMENTS BY MODEL MODEL ONE (Director/Scholarship Recipient is an employee of sponsoring center) Option 1 I. The Early Childhood Administration Credential Scholarship Program Candidate must: A.

Pay 10% of the cost of tuition and books for each course, up to a maximum of 12 semester credit hours; and

B.

Remain employed at the sponsoring center for one full year upon completion of the scholarship contract.

II.

The candidate’s Sponsoring Center must:

A.

Reimburse CCSA upon receipt of a bill for 10% of the cost of tuition and books for each course, up to a maximum of 12 semester credit hours;

B.

Award scholarship recipient a $150 bonus upon successful completion of the Administration Credential;

C.

Provide CCSA with demographic information about the center, upon request, to satisfy reporting requirements to granting agencies; and

D.

Notify CCSA within 10 days of any changes in recipient’s employment status.

III.

Child Care Services Association will:

A.

Pay the participating Community Colleges for the tuition of each scholarship recipient or reimburse scholarship recipients for 90% of the cost of tuition and books for each course;

B.

Bill the sponsoring center for 10% of the cost of tuition and books;

C.

Pay scholarship recipients $50 per semester to help cover the cost of travel;

E.


F.

Regularly communicate with the scholarship recipient’s Community College; and

G.

Comply with the reporting requirements of each funding source. (continued on reverse)

©Revised 2001 Child Care Services Association

MODEL ONE (Director/Scholarship Recipient is an employee of sponsoring center) Option 2 I.

The Early Childhood Administration Credential Scholarship Program Candidate must:

A.

Pay 10% of the cost of tuition and books for each course, up to a maximum of 12 semester credit hours; and

B.

Remain employed in the early childhood field for one full year upon completion of the scholarship contract.

II.

The candidate’s Sponsoring Center must:

A.


B.

Provide CCSA with demographic information about the center, upon request, to satisfy reporting requirements to granting agencies; and

C.

Notify CCSA within 10 days of any changes in recipient’s employment status.

III.


A.

Pay the participating Community Colleges for the tuition of each scholarship recipient or reimburse scholarship recipients for 90% of the cost of tuition and books for each course, up to a maximum of 12 semester credit hours;

B.

Bill the sponsoring center for 10% of the cost of tuition and books;

C.


D.


E.


F.

Comply with the reporting requirements of each funding source.

MODEL TWO (Director/Scholarship Recipient is also owner of sponsoring center) I.

The Candidate/Sponsoring Center must:

A.


B.

Maintain operation of the sponsoring center for one full year upon completion of the scholarship contract; and

C.

Provide CCSA with demographic information about the center, upon request, to satisfy reporting requirements to granting agencies.

II.


A.

Pay the participating Community Colleges for the tuition of each scholarship recipient or reimburse scholarship recipients for 80% of the cost of tuition and books for each course, up to a maximum of 12 semester credit hours;

B.

Bill the candidate/sponsoring center for 20% of the cost of tuition and books;

C.


D.


E.


F.

Comply with the reporting requirements of each funding source.

For additional information about the Early Childhood Administration Credential Scholarship Program or the T.E.A.C.H. Early Childhood® Program, contact Child Care Services Association at (919) 967-3272. www.childcareservices.org