TUITION ASSISTANCE PACKET

Transcription

1 TUITION ASSISTANCE PACKET Use this form to ensure you have all the necessary documents ready to apply for Tuition Assistance. Refer to the Tuition Assistance Packet for specific information about required documentation. Student s Name: A#: FORM/ITEM NOTES 1. Application for Academic Financial Support Complete and submit one form for each class you re registered for. Please leave no blanks and proofread for accuracy 2. Student Information Form Please complete thoroughly Proofread for accuracy 3. Request to Share Information This form allows the school to share grades, fee payment information, etc as needed by TECTA to provide tuition assistance. 4. Orientation Certificate OR Transcripts NEW CDA Students Certificate Continuing Students - Transcripts 5. Student Detailed Schedule Contact the TECTA office if you aren t sure which courses to register for. 6. Account Detail (Statement of Fees) Optional: You may pay your student portion online at this time 7. Proof of Employment See notes regarding appropriate documentation 8. Student Portion of Tuition Continuing Students: Do not fax or with tuition assistance packet. Bring in person on voucher pick-up day. NEW CDA STUDENTS (First Semester Only) Bring your completed packet to voucher days. ALL OTHER STUDENTS: Fax or (recommended) by deadline. NOTE: Watch for a confirmation by stating we have received your documentation. It is your responsibility to contact the TECTA office if you do not receive confirmation within two (2) business days of submitting. Fax: tecta@apsu.edu This project is funded by the Center of Excellence for Learning Science at Tennessee State University through a contract with the Tennessee Department of Human Services

2 TECTA Application for Academic Financial Support Center of Excellence for Learning Sciences w Tennessee State University Phone : (931) Austin Peay State University PO Box 4514 Clarksville, TN Course Information College/University Semester Year Textbook Only Course Name Subject Course Number Section Personal Information Name: Last First Middle Social Security Number - - Gender: Male Female Citizenship: United States Other Date of Birth / / Ethnicity: Hispanic Non -Hispanic Race: Asian Pacific Islander Black Native American Indian/Alaska Native Other Two or more races White Home Address City State Zip Home County Home Phone ( ) Mobile Phone ( ) Emergency Contact Person Phone ( ) Academic degree program this semester: Administrator Credential Desired Major: CDA Prep Associate Degree Early Childhood Education Graduation Status: CDA Renewal Bachelors Degree Elementary Education I will graduate this semester: Yes Technical Certificate Graduate Degree Pre-K Other No Employment Information Your Place of Employment County where you Work Work Address City State Zip Name of Director: Last First Phone ( ) Fax ( ) Director s Agency Type Center Dept. of Education Higher Education Registered Home Visitor Unregulated Family Group Home High School Eligibility I understand that I am enrolling in an academic course and will be responsible for completing the class. Failure to complete all information on this form will result in my application not being processed. If for any reason I cannot finish the course, I will submit notice to the TECTA office in writing immediately, return textbook(s), and agree to pay the entire tuition fee for re-enrollment in a TECTA class. In order to qualify for continued TECTA support, each student must provide a transcript showing that they completed and passed the previous course(s) for which they received financial support from the TECTA program. By signing below I give permission to the institution to release my academic progress and records to representatives from the Tennessee Early Childhood Training Alliance. Signature Date The TECTA program is funded through a contract with the Tennessee Department of Human Services and Tennessee State University, Center of Excellence for Learning Sciences. Revised 2/2017

3 TECTA Application for Academic Financial Support Center of Excellence for Learning Sciences w Tennessee State University Phone : (931) Austin Peay State University PO Box 4514 Clarksville, TN Course Information College/University Semester Year Textbook Only Course Name Subject Course Number Section Personal Information Name: Last First Middle Social Security Number - - Gender: Male Female Citizenship: United States Other Date of Birth / / Ethnicity: Hispanic Non -Hispanic Race: Asian Pacific Islander Black Native American Indian/Alaska Native Other Two or more races White Home Address City State Zip Home County Home Phone ( ) Mobile Phone ( ) Emergency Contact Person Phone ( ) Academic degree program this semester: Administrator Credential Desired Major: CDA Prep Associate Degree Early Childhood Education Graduation Status: CDA Renewal Bachelors Degree Elementary Education I will graduate this semester: Yes Technical Certificate Graduate Degree Pre-K Other No Employment Information Your Place of Employment County where you Work Work Address City State Zip Name of Director: Last First Phone ( ) Fax ( ) Director s Agency Type Center Dept. of Education Higher Education Registered Home Visitor Unregulated Family Group Home High School Eligibility I understand that I am enrolling in an academic course and will be responsible for completing the class. Failure to complete all information on this form will result in my application not being processed. If for any reason I cannot finish the course, I will submit notice to the TECTA office in writing immediately, return textbook(s), and agree to pay the entire tuition fee for re-enrollment in a TECTA class. In order to qualify for continued TECTA support, each student must provide a transcript showing that they completed and passed the previous course(s) for which they received financial support from the TECTA program. By signing below I give permission to the institution to release my academic progress and records to representatives from the Tennessee Early Childhood Training Alliance. Signature Date The TECTA program is funded through a contract with the Tennessee Department of Human Services and Tennessee State University, Center of Excellence for Learning Sciences. Revised 2/2017

4 TECTA Student Information Form Center of Excellence for Learning Sciences w Tennessee State University TECTA Orientation Location or Institution Attending Social Security Number - - Name Last First Middle Employment Status Your Place of Employment Ages of children in classroom (choose one) o Birth to 8 months o 9 to 17 months o 18 to 36 months o 3 to 5 year olds o School-Age o Family Childcare o Mixed-age Group: Infants o Mixed-age Group: Infants and Preschool o Not a Direct Care Provider TECTA Support Received for: Semester Year Salary: Please note: this question is for research purposes ONLY. Individual responses will not be identified or published. $ per Hour Current Position Title: o Asst. Director o Asst. Director/Teacher o Caregiver/Teacher o DHS Staff o Director o Director/Teacher o Home Visitor o Home Visitor Supervisor o Other o Owner of Program o Sub/Floater o Teacher Aide o Authorized o Volunteer Number of years in current position Number of years in Early Childhood Field Number of years at current place of employment Hours worked per week Do you have children with diagnosed delays or disabilities in your classroom? o Yes o No Number of children in your classroom Please complete the reverse side if you are a first-time TECTA-supported student. The TECTA program is funded through a contract with the Tennessee Department of Human Services and Tennessee State University, Center of Excellence for Learning Sciences. Revised 4/2017

5 TECTA Student Information Form Center of Excellence for Learning Sciences w Tennessee State University Complete this side if this is the first time you are receiving TECTA services. Please check the professional organization(s) to which you belong: o Head Start Association o National Black Child Development Institute o National Family Child Care Association o Tennessee Family Child Care Alliance Highest education level completed before seeking TECTA support o National Association for the Education of Young Children o National Child Care Association o Tennessee Association for the Education of Young Children o Tennessee School-Age Care Alliance o Less than 9th grade o 9th 12th grade (no diploma) o High School Graduate/GED o Some College o Technical Certificate o Associate of Applied Science o Associate Degree o Bachelors/Baccalaureate Degree o Masters/Doctorate Degree College or University of Highest Degree Major: o Early Childhood Education o Elementary Education o Special Education o Other Parents Educational Levels Mother Father Graduation Date of Highest Degree / o Less than 9th grade o 9th 12th grade (no diploma) o High School Graduate/GED o Some College o Technical Certificate o Associate of Applied Science o Associate Degree o Bachelors/Baccalaureate Degree o Masters/Doctorate Degree o Less than 9th grade o 9th 12th grade (no diploma) o High School Graduate/GED o Some College o Technical Certificate o Associate of Applied Science o Associate Degree o Bachelors/Baccalaureate Degree o Masters/Doctorate Degree Professional Objectives Why do you want to participate in TECTA training? (Check all that apply): o Further my education o Help with my job search o Improve my job skills o Obtain a CDA o Obtain a raise/higher pay Have you completed other early childhood training during the last 12 months? o Yes o No Did your employer require the training? o Yes o No Do you plan to continue working in child care? o Yes o No If no, please tell us why NOTICE: If you have changed your name and/or address since you last enrolled in a TECTA-supported course, please fill out a TECTA Student Change of Information Form and return it as soon as possible to your local TECTA site. The TECTA program is funded through a contract with the Tennessee Department of Human Services and Tennessee State University, Center of Excellence for Learning Sciences. Revised 4/2017

6 Records Office Nashville State Community College 120 White Bridge Road Student Services Building Suite 207 Nashville, TN Fax: Request to Share Information forms must be accompanied by a valid photo ID if mailing or faxing the form. Students submitting the form in person must be prepared to show a valid photo ID. Our office will require that the student be the one to submit the form. Student s Name Student ID: I know that the Family Educational Rights and Privacy Act of 1974, as amended (FERPA), protects the privacy of my student educational records and limits access to the information contained in those records. I have indicated below the individual(s) who may have information from my educational records. 1. Name/s Noelle Cannon, Director - Tecta at APSU Relationship to Student Funding Source Address Austin Peay State University - TECTA Office PO Box Clarksville, TN Phone If they ask, I approve the above named individual(s) to be informed about (initial all that apply). my grades my major my academic standing my graduation status my enrollment Student Signature Date Processed by Date Student ID viewed by Date NSCC NSCC is a TBR institution, AA/EEO employer, and does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, religion, creed, national origin, sex, sexual orientation, gender identity/expression, disability, age, status as a protected veteran, genetic information, or any other legally protected class with respect to all employment, programs and activities sponsored by NSCC. Inquiries regarding non-discrimination policies: Director of Human Resources, Human.Resources@nscc.edu, 120 White Bridge Road, , The Nashville State policy on nondiscrimination can be found at Printer: NSCC Copy Center 120 White Bridge Road Nashville TN Quantity: 19500, 2016, NSCC.

7 ORIENTATION CERTIFICATE OR TRANSCRIPTS NEW STUDENTS 1. Make a copy of your TECTA Orientation Certificate 2. Add this copy to your Tuition Assistance Packet 3. Store your original certificate in a safe place where you can always find it RETURNING STUDENTS 1. Log in to your student account (mynscc) using your A# and PIN 2. Choose the Student Tab 3. Select Student Records 4. Select Academic Transcript 5. Click Submit 6. Right click and choose Print 7. Add printed Transcripts to your Tuition Assistance Packet

8 ACCOUNT DETAIL (STATEMENT OF FEES) ALL STUDENTS 1. Log in to your student account (mynscc) using your A# and PIN 2. Choose the Student Tab 3. Choose Student Account 4. Choose Account Detail for Term/Confirm Enrollment/Credit Card Payment 5. Select the Current Term 6. **OPTIONAL: If you wish to pay the student portion of your tuition now you may do so. If not, go to next step. 7. Right Click and Choose Print 8. Add printed Account Detail to your Tuition Assistance Packet

9 STUDENT DETAILED SCHEDULE ALL STUDENTS 1. Log in to your student account (mynscc) using your A# and PIN 2. Choose the Student Tab 3. Choose Student Detail Schedule 4. Right Click and Choose Print 5. Add printed Account Detail to your Tuition Assistance Packet

10 PROOF OF EMPLOYMENT In Licensed Child Care Program In Tennessee All Students 1. Obtain one of the following as proof of employment: Most Recent Pay Stub Letter from Employer Written on Letterhead and Dated within the last 2 weeks Copy of License (Owners only) 2. Make a copy 3. Add printed copy to your Tuition Assistance Packet

11 Student Tuition Portion All Students Students must show their portion of Tuition to TECTA staff prior to being issued a voucher. The following are acceptable payment methods: Personal Check made out to NSCC Money Order made out to NSCC If you chose to pay your portion online through mynscc, your Account Detail/Statement of fees will reflect this and you do not need further documentation. CDA Students: $50 per class All other students: You will be notified of your portion of the tuition when you are notified whether or not you received tuition assistance. Please bring this with you when you pick up your voucher. DO NOT include this in your faxed/ ed packet.