June 9, 1999



Dear Grant Applicant:Thank you for your interest in the FTCC’s Child Care Assistance Program, which provides financial assistance with child care. We are very pleased to offer this service to our students.Attached is a child care assistance application that includes the eligibility requirements for our program. Please note that students applying for assistance must have completed Fayetteville Technical Community College’s Admissions Process. Approval is based on the greatest need. Therefore, students applying for assistance must have a 2021-2022 Federal Student Aid (FAFSA) application on file with the Financial Aid Office on campus.Please complete the child care assistance application and return it to Kindra M. Smith, Advanced Technology Center, Room 244 by Friday, June 11, 2021 before 12:00 p.m. Submit COPIES of all required documents along with your application (See the “Required Documents” on page 2 of application). Applications WILL NOT be accepted without ALL supporting documents.Observe the deadline of Friday, June 11, 2021 before 12:00 p.m. We encourage you to submit your application as soon as possible. Answer all questions. Incomplete applications will not be processed. Writing and signatures must be legible. Complete application using black ink.If you are a continuing or currently enrolled student, a GPA of 2.0 or better must be maintained. Final consideration for the grant will be withheld until summer semester grades are received. You will be responsible for paying the childcare facility a monthly parent fee of $50.00 per child.You will be notified about the status of your application by phone and e-mail.If you are receiving child care assistance through your county’s department of social services, you are ineligible for the PFHE program.The PFHE program is not able to assist with tuition, books, tools, supplies or transportation.Important: all applicants are required to participate in the Parents for Higher Education orientation session. Please choose from the following:Friday, June 18, 2021 in the General Classroom Building (GCB) 108 from 9:00-10:30 a.m. or 11:00-12:30 p.m.OrTuesday, June 22, 2021 in the General Classroom Building (GCB) 108 from 9:00-10:30 a.m. or 11:00-12:30 p.m.These are the only scheduled times for the orientation session. Child care assistance will not be provided during orientation. The orientation is for adult participants only. Attending the orientation is mandatory for participation in the PFHE program. There will be no make-up orientation session. Please RSVP by June 11, 2021 with date and time you would like to attend. If you have any questions or concerns, please call (910) 678-8486.Sincerely,Kindra M. Smith Family Support Services AssociateFayetteville Technical Community CollegeParents for Higher Education (PFHE) Child Care Assistance Program Application2021-2022 Academic YearName: FORMTEXT ?????Social Security Number or Student ID Number: FORMTEXT ?????Date of Birth: FORMTEXT ????? Race: FORMTEXT ????? Sex: FORMTEXT ????? County: FORMTEXT ?????Physical Address: FORMTEXT (Street) FORMTEXT (City) FORMTEXT (Zip) Mailing Address: FORMTEXT (Street) FORMTEXT (City) FORMTEXT (Zip)Home Number: FORMTEXT ????? Cell Number FORMTEXT ????? Work Number: FORMTEXT ?????Email Address: FORMTEXT ?????Marital Status: Single FORMCHECKBOX Married FORMCHECKBOX Separated FORMCHECKBOX Divorced FORMCHECKBOX Widowed FORMCHECKBOX INFORMATION ON CHILDREN LIVING IN THE HOMEFull Name FORMTEXT ????? Social Security FORMTEXT ????? Age FORMTEXT ????? Sex FORMTEXT ????? Child Care Needed: Yes FORMCHECKBOX or No FORMCHECKBOX Full Name FORMTEXT ????? Social Security FORMTEXT ????? Age FORMTEXT ????? Sex FORMTEXT ????? Child Care Needed: Yes FORMCHECKBOX or No FORMCHECKBOX Full Name FORMTEXT ????? Social Security FORMTEXT ????? Age FORMTEXT ????? Sex FORMTEXT ????? Child Care Needed: Yes FORMCHECKBOX or No FORMCHECKBOX Full Name FORMTEXT ????? Social Security FORMTEXT ????? Age FORMTEXT ????? Sex FORMTEXT ????? Child Care Needed: Yes FORMCHECKBOX or No FORMCHECKBOX Full Name FORMTEXT ????? Social Security FORMTEXT ????? Age FORMTEXT ????? Sex FORMTEXT ????? Child Care Needed: Yes FORMCHECKBOX or No FORMCHECKBOX Please indicate which child(ren) name(s) from above are enrolled in Pre-K or Head Start: FORMTEXT ?????EMPLOYMENT INFORMATION Currently Employed: Yes FORMCHECKBOX or No FORMCHECKBOX Current Employer: FORMTEXT ????? Current Job Title: FORMTEXT ????? Hours Per Week: FORMTEXT ?????EDUCATION INFORMATIONLast High School Attended: FORMTEXT ????? Diploma: Yes FORMCHECKBOX or No FORMCHECKBOX Institution: FORMTEXT ????? Last Year Attended: FORMTEXT ????? Degree Received: Yes FORMCHECKBOX or No FORMCHECKBOX Institution: FORMTEXT ????? Last Year Attended: FORMTEXT ????? Degree Received: Yes FORMCHECKBOX or No FORMCHECKBOX FTCC STUDENT STATUS Curriculum: FORMTEXT ????? Student Status: Beginning FORMCHECKBOX Returning FORMCHECKBOX Continuing FORMCHECKBOX Transfer FORMCHECKBOX Projected Graduation Date: Fall 20 FORMTEXT ????? Spring 20 FORMTEXT ????? Summer 20 FORMTEXT ????? or Unsure at this time FORMCHECKBOX INDICATE IF YOU ARE RECEIVING ASSISTANCE FROM THE FOLLOWING SOURCES AND THE AMOUNT RECEIVED FORMCHECKBOX Salary (recipient) $ FORMTEXT ????? FORMCHECKBOX Salary (spouse) $ FORMTEXT ????? FORMCHECKBOX VA Benefits $ FORMTEXT ????? FORMCHECKBOX Child Support/Alimony $ FORMTEXT ????? FORMCHECKBOX Social Security Income $ FORMTEXT ????? FORMCHECKBOX Food Stamps $ FORMTEXT ????? FORMCHECKBOX Section 8 Housing $ FORMTEXT ????? FORMCHECKBOX Assistance from Relatives $ FORMTEXT ????? FORMCHECKBOX WFFA/TANF $ FORMTEXT ????? FORMCHECKBOX Other-Specify $ FORMTEXT ?????Total Monthly Income $ FORMTEXT ????? Total Yearly Income $ FORMTEXT ?????Previous PFHE: Fall 20 FORMTEXT ????? Spring20 FORMTEXT ????? Summer20 FORMTEXT ?????I have read and fully understand the information in the Parents for Higher Education (PFHE) Child Care Assistance Application and certify that the above information is true. The required documents are attached, and I hereby grant my permission to have my records with other agencies verified with the information I have provided. FORMTEXT ????? FORMTEXT ?????Parent/Student SignatureDatePartially funded by:What is your alternate plan if you do not receive childcare assistance through the Parents for Higher Education (PFHE) program? FORMTEXT ?????What other assistance would be beneficial to you? FORMTEXT ?????Required Documents & Statement(s) Certifying Receipt of:Birth Certificate of each Child Social Security of each child needing assistanceMarriage CertificateDivorce Decree, Separation Agreement or Death CertificateCurrent verification of no childcare assistance from the Department of Social Services (DSS) Academic Evaluation 2021-2022 Student Aid Report (SAR) (From FAFSA Website)Proof of monthly income (yours and /or spouse’s pay stubs)Unemployment BenefitsVerification of Child Support V.A. Benefits Social Security Income Food StampsSection 8 Housing WFFA/TANF monthly assistance Workforce DevelopmentVocational Rehabilitation Note: If you have no income you must provide a letter of verification from any person that is providing financial assistance for you.AGREEMENT--Eligibility Requirements/Responsibilities of the ParticipantEligibility RequirementsIf you are an adult who is enrolled or will be enrolled in an approved curriculum and has a household income at 200% or below the Federal Poverty Level and meets one or more of the following requirements:A parent with custody or joint custody of dependent children.A pregnant woman.An unemployed or underemployed homemaker whose primary responsibility is the care of the family but now needs marketable job skills.A displaced homemaker due to death, divorce, separation, or disability of a spouse, and needs job training.Responsibility of the Participant - The Parents for Higher Education (PFHE) Child Care Program participant is required to:Attend PFHE orientation Be enrolled in at least 12 or more curriculum credits during the semester (9 hours continuously throughout the semester) with the majority of the curriculum credit hours in a face-to-face setting.Attend all curriculum classesAttend mandatory weekly one-hour group meetingsMaintain a cumulative GPA of 2.0 or better Be responsible for your child's transportation to and from the child care facility Submit payment of $50.00 parent fee monthly to childcare facilityComplete the Federal Student Aid (FAFSA) Application ProcessApply each academic year to receive child care assistance through PFHESchedule an exit interview before dropping a course and/or withdrawing from schoolReport the following student changes within five days: name, address, and telephone numberNotify the PFHE Coordinator of child’s absence from child careSubmit documents according to deadlines set forthAgreementI understand the eligibility requirements and responsibilities of the Parents for Higher Education (PFHE) FORMTEXT ????? FORMTEXT ?????Parent/Student SignatureDateFOR OFFICE USE ONLY:Date Received: FORMTEXT ????? Approved: YES FORMCHECKBOX or NO FORMCHECKBOX ................
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