Fillable 2018-2019 NC Child Care Grant Application The North (Wayne Community College)

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2018-2019 NC Child Care Grant Application The North (Wayne Community College)

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2018-2019
NC Child Care Grant Application
The North Carolina General Assembly allocates funds to assist student-parents enrolled in state community colleges with
the financial responsibilities associated with child care expenses. All student-parents enrolled for at least six (6) credit
hours in a Title IV approved program may be eligible for this assistance and are encouraged to apply. Child care grant
funds may be awarded to students with demonstrated financial need as determined by the FAFSA and who meet other
eligibility requirements.
WCC student-parents who wish to be considered for the child care grant should return this completed application to the
Financial Aid Office. Funding is limited; therefore, submission of an application does not guarantee that funds will
be awarded.
INSTRUCTIONS: Complete this application, attach a copy of the birth certificate for each child who requires child care
services, sign, and return to the WCC Financial Aid Office. Please note, the awarding process cannot begin until funding
levels for 2018-2019 have been released by the state; for that reason, award notices may not be issued until after Fall
2018 classes begin.
Have you submitted a 2018-2019 FAFSA?
Yes (continue)
No
GENERAL ELIGIBILITY REQUIREMENTS
• Completed 2018-2019 WCC Financial Aid file.
• Unmet financial need.
• Legal resident of NC as determined by the NC
Residency Determination Service (RDS.)
• Enrolled at least half-time (6 + credit hours) in
on-campus and/or hybrid classes as part of a Title IV
eligible program at WCC. (Full-time students will be given
first consideration.)
• Eligible to receive financial aid at WCC as
outlined in the SAP Policy.
• Not receiving child care assistance from outside agencies.
(e.g. DSS, WAGES)
Which semester(s) are you applying for assistance? Fall 2018 Spring 2019
Have you received the NC Child Care Grant at WCC before?
No
If yes, when? _________________
PERSONAL INFORMATION (please type or print clearly)
NAME: __________________________________________________
WCC ID #: ______________________
E-MAIL: _________________________________________________
PHONE: ________________________
What is your current marital status?
Single
Married
Separated
Divorced
Widowed
EDUCATIONAL INFORMATION
What is your status for the 2018-2019 school year? New
Student
Continuing/Returning
Student
Transfer
Student
What is your major? ______________________
What is your grade level?
Freshman
Sophomore
How many credit hours do you plan to take?
Fall 2018: __________
Spring 2019: __________
CHILDREN’S INFORMATION (list all children living in the home)
Full Name Age
Child Care
Needed?
Enrolled in Pre-K
Or Head Start?
Birth Certificate
Attached?
Yes No Yes No Yes On File
Yes No Yes No Yes On File
Yes No Yes No Yes On File
Yes No Yes No Yes On File
2
Are any of the children listed on page 1 currently enrolled in a child care facility?
No
▪ If yes, what is the name of the facility? ___________________________________________________
▪ If no, what are your current child care arrangements?
Home Day Care
Private Sitter
Other ____________________________
Have you been approved for child care assistance through
another agency?
Yes
No
If yes, what agency?
(DSS, WAGES, etc.)
_____________________________
FEDERAL BENEFITS
Do you now receive, or do you expect to receive, any of the following? (check all that apply)
Food Stamps/SNAP TANF/AFDC Social Security/SSI Pell Grant
WIC Vouchers
Housing Assistance
WIOA
VA Non-Education Benefits
CERTIFICATION AND SIGNATURE (INITIAL each item to confirm that you have read it)
I have read and understand all information included on this form.
All information reported on this application is TRUE and CORRECT to the best of my knowledge.
If requested, I will submit documents to verify my financial need.
I understand that this information is being provided for the receipt of funds offered by the State of NC and that
the deliberate misrepresentation of information may be subject to prosecution under state law.
I understand that submission of an application does not guarantee that I will be approved for funding.
I understand that NC Child Care funds may not be awarded until after the Fall 2018 semester begins. If
necessary, I am prepared to accept responsibility for child care payments in the absence of funding.
I authorize the WCC Financial Aid Office to obtain information from other federal or state agencies regarding
funding information and/or program eligibility.
If I am approved for the NC Child Care Grant, I understand that I will be required to maintain at least half-time
enrollment throughout the semester and to provide documentation of my class attendance.
STUDENT SIGNATURE: _________________________________________
DATE: __________________
BIRTH CERTIFICATES ARE REQUIRED FOR ALL CHILDREN REQUIRING CHILD CARE SERVICES
RETURN THIS COMPLETED APPLICATION TO:
Wayne Community College - Financial Aid Office - PO Box 8002 - Goldsboro, NC 27533-8002
**FOR FINANCIAL AID OFFICE USE ONLY**
APPROVED Period Covered: _______________________
DENIED
WAITING LIST
Reason for Denial:
Income too high: EFC = _________
Notice Sent to Student: ________________________________
Date
Incomplete Application
SAP
Other:___________________
___________________________________________________________
Child Care Grant Coordinator Signature
_____________________________
Date
COA
_________
EFC
__________
FA
__________
Sponsors
__________
Unmet Need
__________
TIV
__________
GPA
__________
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2018-2019 NC Child Care Grant Application The North (Wayne Community College)

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Completed 26 July 2020

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