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Carefully read the following points that are essential to your enrollment in the CCAMPIS Program.
• I understand that the goal of the CCAMPIS Program is to assist me with child care
expenses so that I can succeed in completion of credits at LCCC.
• I understand that my participation in the CCAMPIS Program is dependent on my
continuous participation and successful completion of semester/summer session credits.
• I certify that I meet the eligibility criteria listed in the information section of this packet,
including: being a Pell Grant recipient, being in good academic standing, and having my
child enrolled in an Accredited Child Care Facility.
• I agree to contact the Program Director of CCAMPIS immediately if I drop any class
during any semester/summer session or if there are any changes in my child care
arrangements or child care costs. I understand these changes may affect my eligibility in
the CCAMPIS Program.
• I authorize LCCC and the CCAMPIS selection committee to access my personal, financial,
and academic information to determine my eligibility of enrollment. I also authorize LCCC
and the CCAMPIS selection committee to report statistical data, including but not limited to,
information regarding my academic progress, and race/ethnicity to the Federal Government.
• I understand that I will be asked to participate in an evaluation of the CCAMPIS Program,
and participate in family centered training presented each semester.
• I understand that I will attend two (2) parent workshops annually.
• I understand that a reduction or cancellation of my subsidy could result from: loss of
funding from the U.S. Department of Education, withdrawal from classes anytime during the
semester, withdrawal from LCCC, withdrawal of my child from the child care setting and/or
failure to comply with the rules of the program. I also understand that I will be financially
responsible for my child care expenses if I am removed from the CCAMPIS Program.
• I understand I must be enrolled in a minimum of six (6) credits per semester and my
child/children enrolled in child care a minimum of two (2) half days.
• I understand that I am responsible for child care fees that are not covered by my CCAMPIS
Scholarship, including time when classes are not in session as per the Academic Calendar.
• I UNDERSTAND THAT THE CCAMPIS SCHOLARSHIP MAY NOT PAY ALL OF MY CHILD
CARE EXPENSES. THERE MAY BE A FINANCIAL RESPONSIBILITY ON MY PART.
My signature on this application indicates my willingness to fully participate in the CCAMPIS
Program at Lehigh Carbon Community College. I will fully comply with all program requirements,
including but not limited to the ones listed above. I hereby certify that the information I provided
on this application is true and correct to the best of my knowledge.
LCCC Student Signature: _____________________________ Date: _____________________
Please return completed application to Kathy Meath at kmeath@lccc.edu or
CCAMPIS, 4525 Education Park Drive, Schnecksville, PA 18078.
The College will not discriminate against any employee, applicant for employment, student, or applicant for admission on the basis of gender, gender identity, gender expression, sex, race,
ethnicity, color, national origin, religion, age, disability, veteran or military status, genetic information, family or marital status, sexual orientation, or any other protected class under applicable local,
state, or federal law, including protections for those opposing discrimination or participating in any grievance process on campus or within the Equal Employment Opportunity Commission or other
human rights agencies. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence,
compensation, and training. Inquiries about this policy and procedure may be made internally to the Director of Human Resources/Title IX/Equity Coordinator, Office of Human
Resources, 4525 Education Park Drive, Schnecksville, PA 18078, 610-799-1107. PERM10B-h (AC) 4/27/20
