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Attention:
This form is applicable on a per term basis to CCM CCAMPIS subsidy students only, based on their completing the Free Application for Federal Student Aid
(FAFSA) process with PELL grant eligibility. Limited subsidy available, apply early.
CCM-CCAMPIS SUBSIDY STUDENT APPLICATION
Academic Semester applying for: ___________
Semester(s) you plan to enroll at County College of Morris (Select all terms that apply below)
Fall
Spring
Winterim
Summer
Credits:_____
Credits:_____
Credits:_____
Credits:_____
Current CCM Major:
PLEASE READ EACH SECTION CAREFULLY BEFORE SIGNING.
About the Grant:
CCAMPIS stands for
Child Care Access Means Parents In School. It is a federally funded grant, which County College of Morris
received to assist student parents with their childcare cost while completing their degree.
The grant award is a 4 year federal grant
through the US Department of Education, however all applicants must apply every year,
and provide all necessary documentation and fulfill all requirements.
Student parent applicants are considered for childcare assistance through CCAMPIS funding on the basis of eligibility status,
financial income, need, resources and family contribution levels as per their FAFSA results.
To learn more about the U.S. Department of Education’s CCAMPIS Program visit:
https://www2.ed.gov/programs/campisp/index.html
Student Name (LFM):
CCM ID#:
*Dependent Name:
1. ___________________________________________
2. ___________________________________________
*Dependent
1. Age: _____
2. Age: _____
Mailing Address:
Email: _____________________________________________
Phone
(Select preferred)
Home: _____________________________
Cell: _____________________________
Work: _____________________________
* Please submit a copy of your child’s birth certificate or Legal Guardianship Court document to the Financial Aid Office, Location: Student
Community Center, room 210 or email a clear copy indicating your CCM student id# to finaid@ccm.edu
with subject line “CCAMPIS”.
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CCM CCAMPIS ELIGIBILITY REQUIREMENTS & GUIDELINES
1. Must file the Free Application for Federal Student Aid (FAFSA), identifying CCM as your school of choice
2. Must be a U.S. Citizen or Eligible Non-Citizen
3. Must receive a PELL Grant or be PELL eligible based on the Expected Family Contribution (EFC #) on the FAFSA.
4. Enroll for a minimum of six (6) approved credits each term at County College of Morris
5. Any change in registration status will impact the CCAMPIS subsidy.
6. Participate in program orientation, intensive academic advising, tutoring toward academic success.
7. Register for courses required for your current CCM program of study
8. Maintain Satisfactory Academic Progress in your course of study (major).
9. Academically identified at risk students will be referred to The Academic Success Center (TASC) and Tutoring Center for academic support
10. Class attendance confirmation each term and adherence to County College of Morriscourse withdrawal policy
11. CCM subsidy payment is last dollar after all other facility tuition benefit and or subsidy payment (your out of pocket cost).
12. Participating student parent must select a Childcare facility pre-approved by the CCM CCAMPIS authorized personnel
13. Submit proof of your dependent(s) Example: Birth certificate or Legal Guardianship Court document (if applicable)
14. Disclose your dependent(s) name, age and selected childcare facility term invoice with this application.
CCM-CCAMPIS APPROVED PARTICIPATING CHILDCARE FACILITY LOCATIONS:
SELECT YOUR CHOICE BELOW
(Select one only)
Dover
Hopatcong
Lake
Hopatcong
Montville
Mt. Olive
Parsippany
Roxbury
SELECTED CHILDCARE FACILITY SECTION:
Childcare Facility Representative completing this section:
Street Address:
City: State:
Zip:
Name:
Title
Phone:
Email
Email:
Signature/Date
Important: This form is only applicable to CCM CCAMPIS Subsidy grant eligibility, with payment as last dollar after all other term tuition benefits/subsidy (Your out of
pocket cost); and directly to your selected, approved Childcare Facility for your above listed dependent(s) of which is not transferrable for other dependents not
listed. Adherence is required to all federal and the County College of Morris policies and procedures, which include the student code of conduct. Additionally, the
subsidy is not applicable toward tuition payment, cover childcare cost in full (percentage based on your estimated family contribution (EFC)) nor subsidy for past
semester(s) childcare cost.
CERTIFICATION:
By signing below, I acknowledge that I understand the information above and all information given is true and complete to the best of my knowledge. I further agree
to submit proof of the above information upon request, understanding that if I do not submit all requested documentation my request will be denied. I also
understand that if granted the CCM Childcare subsidy, that the amount is subject to reduction, cancellation and or repayment to CCM based on corrections made to
my initial FAFSA
and or changes in my enrollment activity. I understand that failure to meet all requirements; I will be fully responsible for paying the Childcare Facility
for my dependent.
Student Signature: _______________________________________________________________________________ Date: ____________________
COUNTY COLLEGE OF MORRIS FINANCIAL AID OFFICE (CCAMPIS) USE ONLY
Approved
Childcare Facility Name:
No. Dependents: ____
[ ] Infant (0-1)
[ ] Toddler (1-3)
[ ] Preschool (3-5)
Denied
Term:
Enrollment: FT/QT (9 or more) [ ] ; PT (6-8.5) [ ]
EFC#:
CCAMPIS Subsidy: 75% [ ] | 60% [ ] | 50% [ ] | 30% [ ] | Other [ ]
Subsidy Amount: $
Reason if Denied
CCM Authorized Signature: ______________________________________________________________________ Date: ___________________
Student Name
CCM ID#
CCMFAA. 3/10/2020
Print, Sign and submit to the Financial Aid Office