Fill - Free fillable TA Degree (Southwest Tennessee Community College) PDF form

Tennessee Early Childhood Training Alliance

Southwest Tennessee Community College

737 Union Avenue, E-105

Memphis, TN 38103

(901) 333-5541

fax: (901) 333-5750

www.southwest.tn.edu\tecta

Southwest Tennessee Community College

737 Union Avenue Memphis, TN 38103  (901) 333-5600 www.southwest.tn.edu

March 25, 2016

Dear TECTA Scholarship Recipient,

I hope you are enjoying the spring! It is time to register for classes and submit scholarship applications for the

summer and fall 2016 semester. We are committed to providing as much tuition assistance as possible to

students but funds are limited!

For the summer semester, TECTA will provide tuition assistance for two courses toward the CDA Credential.

Funds are available for one course toward early childhood associate and bachelor degrees. Please make sure

you include a working email address on your application so we can communicate with you. TECTA funds are

limited so if you plan to take a course and receive tuition assistance you need to register, submit the

enclosed applications, and pay the student portion prior May 13, 2016. Those who register after May 13

may not receive funding.

A few things to remember:

 Funds are available on a first come – first serve basis. Please register and pay your fees early to ensure

funds are available.

 Your must submit all of the items listed on the enclosed checklist for your application to be considered.

 You must register and pay your portion of the fees before TECTA funds can be attributed (funds are not

guaranteed until you pay your portion and funds are placed on your account).

 In order for TECTA to have time to award a scholarship for a course at Southwest, your fees are due by

o by 3:30 on May 13

for early registration

o by 3:00 on the day of registration during regular registration if funds are still available

 Students cannot receive a refund from Federal Financial Aid and TECTA.

We strongly recommend that all students apply for federal financial aid or other scholarships. You can

apply for federal financial aid online at www.fafsa.gov. You can obtain more information about financial

aid and other scholarships available at Southwest online at www.southwest.tn.edu/financial_aid.

We know many of you have worked hard over the past few years and are very close to completing your degrees.

We are pleased to still be able to offer some tuition assistance. We thank you for letting TECTA be a part of

your educational journey! Please let us know as you achieve your goals.

If you have any questions, feel free to call me at 333-5534. We look forward to seeing you soon!

Sincerely,

Elizabeth O. Wilson, MS

TECTA – Southwest Director

Tennessee Early Childhood Training Alliance

Southwest Tennessee Community College

737 Union Avenue, E-105

Memphis, TN 38103

(901) 333-5541

fax: (901) 333-5750

www.southwest.tn.edu\tecta

TECTA Tuition Assistance Check List for “Degree Seeking Students”

Please note that all boxes must be checked and materials attached for your application to be

processed. Incomplete applications will not be processed!

Tuition Payment Information:

For students attending Southwest:

 You may pick up your payment voucher in the TECTA office or call the office (333-5541) and request it be

mailed to you.

 TECTA cannot make a scholarship payment until you turn in a copy of your most recent grades and pay the

student portion of your fees.

 To ensure that TECTA has time to make a scholarship payment, the student portion is due:

by 3:30 pm on May 13, 2016 for early registration

by 3:00 pm on the day of registration during regular registration if funds are still available.

 Students are not eligible to receive a refund from federal financial aid and TECTA. If you receive federal

financial aid your TECTA award amount may be adjusted.

For students attending somewhere other than Southwest:

 TECTA can provide assistance with one BA level course.

 The TECTA office requires two weeks to process your application and create a payment voucher.

 Vouchers cannot be given without a copy of your grades from the last semester you took courses.

 You will be called at your home number when the voucher is ready for pick up. You may call 333-5541 to

check on the status of your voucher.

 Students are not eligible to receive a refund from federal financial aid and TECTA. If you receive federal

financial aid your TECTA award amount may be adjusted.

* Funds are limited this year and are available on a “first come first serve” basis. TECTA cannot make a payment or guarantee

funds availability until you register for your course and pay the student portion of your fees.

This checklist and all needed documents may be

faxed to 333-5750 or brought to the TECTA office. Student Signature

Completed Application for Academic Financial Support

Student Information Form

Student Request to Share Information

Copy of your Summer 2016 course schedule

Printout showing current major/program of study

Copy of check stub as proof of employment in a licensed early childhood program

Grades for the last semester you attended classes

TSU-TECTA

Center of Excellence for Learning Sciences Revised 12/

17/2013

Tennessee State University Form: TECTA Tuition Assistance Request

Tennessee Early Childhood Training Alliance (TECTA)

Application for Academic Financial Support

Tennessee Early Childhood Training Alliance

College/University _________________________ Semester ________ Year______________ Textbook Only

Course Name ______________________________ Subject ________Course Number _______ Section ___________

Name: Last______________________________ First ______________________________ Middle ________________

Social Security Number ________-_____-__________ Gender: Male Female

Citizenship: United States Other E-mail _____________________________________________

DOB ____/_______/______ Ethnicity: Hispanic Non -Hispanic

Race: Asian Pacific Island Black Native American Indian/Alaska Native

Other Two or more races White

Address_________________________________________City __________________ State ________ Zip____________

Home County ____________________Home Phone (_____) ________________ Cell Phone (_____) _______________

Emergency Contact Person_____________________________________ Phone (_____) __________________________

Academic degree program this semester: Choose One

CDA Prep CDA Renewal Technical Certificate Administrator Credential

Associate Degree Bachelor Degree Graduate Degree

Desired Major Early Childhood Education Elementary Education PreK Other_________________

Graduation Information I will graduate this semester yes no

Place of Employment__________________________________________________ Work County___________________

Work Address______________________________________City _______________State__________ Zip____________

Name of Director: Last____________________________ First________________________________________

Phone (_____) ______________ Fax (_____) ________________ E-mail _________________________________

Eligibility

In order to qualify for continued TECTA support, the student must provide a transcript showing that he/she completed and passed the previous course(s) for

which he/she received financial support from the TECTA program.

NOTICE: If you have changed your name and/or address since you last enrolled in a TECTA-sponsored course, please fill out a Change of Name/Address form

and return it as soon as possible to the local TECTA site.

I understand that I am enrolling in an academic course and will be responsible for completing the class. Failure to complete all information on this form will

result in your application not being processed. If for any reason I cannot finish the course, I will submit notice to the TECTA office in writing immediately,

return textbook, and agree to pay the entire tuition fee for re-enrollment in a TECTA class. In addition, I grant TECTA permission to access my academic record.

Signature _________________________________________________ Date ______________________

“This project is funded through a contract with the Tennessee Department of Human Services and Tennessee State University,

Center of Excellence for Learning Sciences.”

Southwest Tennessee Community College

Phone : (901) 333-5541

Memphis, TN 38101

P O Box 780

SUMMER 2016

Summer 2016

Center of Excellence for Learning Sciences Revised 12/16/2013

Tennessee State University

TSU-TECTA Form: TECTA Student Information

Tennessee Early Childhood Training Alliance (TECTA)

Student Information Form

7HQQHVVHH(DUO\&KLOGKRRG7UDLQLQJ$OOLDQFH

PLEASE PRINT CLEARLY. Semester ________Year _______________________

TECTA Orientation Location or Institution Attending ___________________________________________________

Social Security Number: _________________-________________-_________________

Name: Last_____________________________ First ________________________ Middle ______________

Employment History

Ages of children in classroom (choose one)

Birth to 8 months 9 to 17 months 18 to 36months Ages3 – 5 Sc

hool Age

Mixed Age G

roup Infants Mixed age group Infant & Preschool Family Childcare

Please note this question is for research purposes ONLY. Individual responses will not be identified and published.

Salary $ __________ per Hour day week bi-weekly month year

Current Position Title: Asst. Director Asst. Director/Teacher Caregiver/Teacher Director

Director/Teacher Other Owner of Program Sub/Floater

Asst. Teacher Volunteer

Number of years in current position ________ Number years in Early Childhood Field ______.

Number of years at current place of employment: _______ Hrs worked per week:_____________

Do you have children with diagnosed delays or disabilities in your classroom? yes No

Number of Children in classroom____________

Please check the professional organization(s) to which you belong:

Head Start Association

National Association for the Education of Young Children

National Black Child Development Institute

National Child Care Association

National Family Child Care Association

Tennessee Association for the Education of Young Children

Tennessee Family Child Care Alliance

Tennessee School-Age Care Alliance

3OHDVHFRPSOHWHWKHUHYHUVHVLGHLI\RXDUHILUVWWLPH7(&7$VXSSRUWHGVWXGHQW

Memphis, TN 38101

Phone : (901) 333-5541

P O Box 780

Southwest Tennessee Community College

Summer 2016

Center of Excellence for Learning Sciences Revised 12/16/2013

Tennessee State University

TSU-TECTA Form: TECTA Student Information

Complete this portion only the first time you receive TECTA services

Highest educational achievements before seeking TECTA support

< 9

grade 9

– 12

grade (no diploma) High School Graduate/GED

some college Technical certificate Associate Applied Science

Associate Baccalaureate Masters/Doctorate

College or university of highest degree ________________________________________________________

Major: Early Childhood Education Elementary Education Special Education Other _______________

Graduation Date ______/_________

Parents Educational Levels:

Mother < 9

grade 9

– 12

grade (no diploma) High School Graduate/GED

some college certificate Associate

Baccalaureate Masters/Doctorate

Father < 9

grade 9

– 12

grade (no diploma) High School Graduate/GED

Vome college  certifi

cate  Associate

Baccalaureate

Masters/Doctorate

Professional Objectives

Why do you want to participate in TECTA training? (Check all that apply):

Further my education Help with my job search Improve my job skills Obtain CDA Obtain raise

I have completed other early childhood training during the last 12 months Yes No

Was the training required by your employer? Yes No

Do you plan to continue working in child care? Yes No

If no, please tell why_________________________________________________________________

NOTICE: If you have changed your name and/or address since you last enrolled in a TECTA-sponsored course, please fill out a

Change of Name/Address form and return it as soon as possible to the local TECTA site.

³7KLVSURMHFWLVIXQGHGWKURXJKDFRQWUDFWZLWKWKH7HQQHVVHH'HSDUWPHQWRI+XPDQ6HUYLFHVDQG7HQQHVVHH6WDWH

8QLYHUVLW\&HQWHURI([FHOOHQFHIRU/HDUQLQJ6FLHQFHV´



Student Request to Share Information

Office of Admission and Records

Southwest Tennessee Community College

Name of institution where student is enrolled

Student’s Name ______________________________________________________________

(Please Print) Last First Middle Initial

SS# ___________________________________________

Address: _________________________________________________

Street

_________________________________________________

City State Zip Code

Phone: ( )_________ ____

Semester: ________________ Year:____________

I know that the Family Educational Rights and Privacy Act of 1974, as amended

(FERPA), protects the privacy of my student educational records and limits access to the

information contained in those records. Because I receive financial support covering all or part of

my tuition from the TSU-TECTA program, I am hereby authorizing the Southwest Tennessee

Community College Office of Admission and Records to release my grades and academic status

information to the local TECTA Site Director for transmission to the TSU-TECTA Management

Office. The information will be used to determine and verify my eligibility for continued TSU-

TECTA financial support and will be protected in accordance with the provisions FERPA. My

grade and academic status information should be sent to:

Name: _Elizabeth O. Wilson , Southwest -TECTA Director

Address: __Southwest Tennessee Community College ______

__P.O. Box 780 ________________________

__Memphis, TN 38101-0780__ _________________

__(901) 333-5541 ________________________

__________________________________ _____________________________

Student’s Signature Date

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

TA Degree (Southwest Tennessee Community College)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank TA Degree (Southwest Tennessee Community College) Form

Related forms

Fillable TA Degree (Southwest Tennessee Community College)

Fill Online, Printable, Fillable, Blank TA Degree (Southwest Tennessee Community College) Form

Related forms

First 20 documents completely FREE!