Continued on Reverse
2020-2021
NC Childcare Grant Application
NAME: _____________________________________________
WCC ID:
ADDRESS: _____________________________
CITY:
______________________
STATE: _______
ZIP: __________
The North Carolina General Assembly allocates funds each year to assist student-parents enrolled in state community colleges
with the financial responsibilities associated with childcare expenses. All student-parents enrolled at least half-time in a Title IV
approved program may be eligible for this assistance and are encouraged to apply. Childcare 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 childcare assistance should complete this application and return it to the
Financial Aid Office. Funding is limited; therefore, submission of an application does not guarantee that funds will be
awarded. PLEASE NOTE the awarding process will not begin until funding levels for 2020-2021 have been released by the
state; for that reason, award notices typically are not issued until AFTER Fall classes begin.
INSTRUCTIONS: Complete this application using blue or black ink, attach a copy of the birth certificate for each child who
requires childcare services, sign, and return the completed package to the WCC Financial Aid Office.
GENERAL ELIGIBILITY REQUIREMENTS
2020-2021 WCC Financial Aid file must be complete
Have unmet financial need
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 may be
given priority consideration)
Legal resident of NC as determined by the NC
Residency Determination Service (RDS)
Eligible to receive financial aid at WCC as outlined in
the SAP Policy
Head Start, WAGES, etc.
Have you completed the 2020-2021 FAFSA? Yes (continue) No (stop here- you are not eligible)
Please indicate which semester(s) you will need childcare assistance:
Fall 2020
Spring 2021
The NC Child Care Grant is not available for the summer term.
Have you received the NC Child Care Grant at WCC in the past?
What is your current marital status?
Single
Married
No Yes If yes, when?
___________
Separated Divorced Widowed
Beginning with the 2020-2021 school year, you will be a:
New Student
Returning Student
Transfer Student
What is your major?
What is your grade level?
Freshman
Sophomore
Expected Enrollment: Fall 2020: ________ credits Spring 2021: ________ credits
CHILDREN’S INFORMATION (list all children living in the home)
Full Name Age
Child Care
Services 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
Yes No Yes No Yes
On File
Are any of the children listed on page 1 currently enrolled in a licensed childcare facility? Yes No
If yes, what is the name of the facility?
If no, what are your current childcare arrangements? Home Daycare Private Sitter
Other
Have you been approved for childcare assistance through another agency?
No
Yes If yes, which agency?
_______________________
Do you currently receive, or do you expect to receive, any of the following?
(check all that apply)
Food Stamps/SNAP
TANF/AFDC
WIOA
VA Non-Educational Benefits
WIC
Subsidized Housing
Scholarships
Private Student Loans
Medicaid
Social Security/SSI
Other: ______________________________________
CERTIFICATION AND SIGNATURE (INITIAL each statement to confirm that you have read and understand 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 agree to 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
intentional 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 Grant funds may not be awarded until AFTER the Fall 2020 semester begins. I am
prepared to accept responsibility for childcare 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 my class attendance will be monitored to ensure
that I maintain at least half-time enrollment (6 or more credit hours) throughout the semester.
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
FINANCIAL AID OFFICE USE ONLY
File Complete?
Yes No
COA
________________
- EFC
______________
- FA
______________
- SPONSORS
_____________
= UNMET NEED
_____________
SAP STATUS: ____________
GPA: _______
PACE: _______
TIV Credits Fall: ______
TIV Credits Spring: _____
Seated _____
Online _____
Seated _____
Online _____
Approved
Wait List
Denied
Period Covered: ____________________
Reason: _________________________
FA Office Signature: __________________________________________ Date: ____________________
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