Fillable TA Degree AS (Southwest Tennessee Community College)

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

Use Fill to complete blank online SOUTHWEST TENNESSEE COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

TA Degree AS (Southwest Tennessee Community College)

On average this form takes 53 minutes to complete

The TA Degree AS (Southwest Tennessee Community College) form is 6 pages long and contains:

  • 0 signatures
  • 66 check-boxes
  • 183 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Southwest Tennessee Community College

BROWSE SOUTHWEST TENNESSEE COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Tennessee Early Childhood Training Alliance
Southwest Tennessee Community College
737 Union Avenue, Suite F – 307
Memphis, TN 38103
(901) 333-5541
fax: (901) 333-5750
www.southwest.tn.edu\tecta
May 1, 2019
Dear TECTA Scholarship Recipient,
I hope you are having a good semester! It is time to register for classes and submit scholarship applications for
the fall 2019 semester. I am excited to say that we have a large amount of tuition funds available to help you
achieve your goals!
This semester, TECTA can provide tuition assistance for two courses per semester toward the CDA Credential
technical certificate, and associate degrees. We can also connect you with TN Reconnect if you are interested in
receiving funding for your full tuition. The priority deadline for summer funding is August 1, 2019.
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 3:00 on August 12th 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 or TN Reconnect and TECTA.
We strongly recommend that all students working toward degrees apply for federal financial aid, TN
Reconnect (100% funding for associate degrees), or other scholarships. I am happy to talk with you
about any of these options. You can apply for federal financial aid online at www.fafsa.gov. You can
apply for TN Reconnect at http://www.tnreconnect.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 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
Southwest Tennessee Community College
737 Union Avenue Memphis, TN 38103
(901) 333-5600 www.southwest.tn.edu
Tennessee Early Childhood Training Alliance (TECTA)
Southwest Tennessee Community College
737 Union Avenue
M Building, room 316
Memphis, TN 38117
P: (901) 333-5541 F: (901) 333-5750
TECTA Tuition Assistance Check List
For students pursuing a Technical Certificate or Associate Degree
Please review the list below. All materials MUST be attached to your application for your
application to be complete. Incomplete applications cannot be processed.
Tuition Payment Information:
If you plan to pay your tuition online, you may do so through the student portal of http://my.southwest.tn.edu
If you plan to pay your tuition in person, you will first need to pick up your payment voucher in the TECTA
office or call the office (333-5541) and request it be mailed to you. You will not be able to pay your tuition in
the Cashier’s office without a voucher. Once you have the voucher, you may go to the Cashier’s office on the
Union Avenue (M Building 107) or Macon Cove (Farris Building 2032) campuses.
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 August 12th, 2019 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.
TECTA funds are not guaranteed until you have paid the student portion of the tuition and submitted a
complete TECTA Application for Academic Financial Support packet.
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 (one for each course)
Student Information Form
Student Request to Share Information
Copy of your Fall 2019 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
The TECTA program is funded through a contract with the Tennessee
Department of Human Services and Tennessee State University,
Center of Excellence for Learning Sciences.
Revised 2/2017
Center of Excellence for Learning Sciences w Tennessee State University
TECTA Application for Academic Financial Support
Course Information
College/University __________________________________ Semester Fall Year_2019_________ Textbook Only_____
Course Name ______________________________________ Subject ________Course Number ________ Section
_________ Personal Information
Name: Last ___________________________________ First __________________________ Middle ___________________
Social Security Number _____-_____-______ Gender: Male Female
Citizenship: United States Other E-mail ________________________________________________________
Date of Birth _____/_____/_______ Ethnicity: Hispanic Non -Hispanic
Race: Asian Pacific Islander Black Native American Indian/Alaska Native Other
Two or more races White
Home Address ______________________________________________________________________________________
City ______________________________________________________ State ________ Zip ___________
Home County ________________________________ Home Phone (___)____________ Mobile Phone (___)____________
Emergency Contact Person _________________________________Phone (___)____________
Academic degree program this semester: CDA Prep CDA Renewal Technical Certificate
Administrator Credential Associate Degree Bachelors Degree Graduate Degree
Desired Major: Early Childhood Education Elementary Education Pre-K Other________________
Graduation Status: I will graduate this semester: Yes  No
Employment Information
Your Place of Employment ______________________________________ County where you Work ____________________
Work Address _________________________________________________________________________________________
City _______________________________________________ State _______ Zip ___________
Name of Director: Last ________________________________ First _____________________________
Phone (___)____________Fax (___)____________ Director’s E-mail _____________________________________________
Agency Type
Center Dept. of Education Home Visitor Family Group Home High School
Higher Education Registered Unregulated
Eligibility
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 my 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(s), and agree to pay the entire tuition fee for re-enrollment in a
TECTA class.
In order to qualify for continued TECTA support, each student must provide a transcript showing that they completed and passed the
previous course(s) for which they received financial support from the TECTA program. By signing below I give permission to the
institution to release my academic progress and records to representatives from the Tennessee Early Childhood Training Alliance.
Signature __________________________________________________________ Date ______________________
Phone : (901) 333-5541
Southwest Tennessee Community College
Memphis, TN 38101
Southwest Tennessee Community College
The TECTA program is funded through a contract with the Tennessee
Department of Human Services and Tennessee State University,
Center of Excellence for Learning Sciences.
Revised 2/2017
Center of Excellence for Learning Sciences w Tennessee State University
TECTA Application for Academic Financial Support
Course Information
College/University __________________________________ Semester Fall Year_2019_________ Textbook Only_____
Course Name ______________________________________ Subject ________Course Number ________ Section
_________ Personal Information
Name: Last ___________________________________ First __________________________ Middle ___________________
Social Security Number _____-_____-______ Gender: Male Female
Citizenship: United States Other E-mail ________________________________________________________
Date of Birth _____/_____/_______ Ethnicity: Hispanic Non -Hispanic
Race: Asian Pacific Islander Black Native American Indian/Alaska Native Other
Two or more races White
Home Address ______________________________________________________________________________________
City ______________________________________________________ State ________ Zip ___________
Home County ________________________________ Home Phone (___)____________ Mobile Phone (___)____________
Emergency Contact Person _________________________________Phone (___)____________
Academic degree program this semester: CDA Prep CDA Renewal Technical Certificate
Administrator Credential Associate Degree Bachelors Degree Graduate Degree
Desired Major: Early Childhood Education Elementary Education Pre-K Other________________
Graduation Status: I will graduate this semester: Yes  No
Employment Information
Your Place of Employment ______________________________________ County where you Work ____________________
Work Address _________________________________________________________________________________________
City _______________________________________________ State _______ Zip ___________
Name of Director: Last ________________________________ First _____________________________
Phone (___)____________Fax (___)____________ Director’s E-mail _____________________________________________
Agency Type
Center Dept. of Education Home Visitor Family Group Home High School
Higher Education Registered Unregulated
Eligibility
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 my 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(s), and agree to pay the entire tuition fee for re-enrollment in a
TECTA class.
In order to qualify for continued TECTA support, each student must provide a transcript showing that they completed and passed the
previous course(s) for which they received financial support from the TECTA program. By signing below I give permission to the
institution to release my academic progress and records to representatives from the Tennessee Early Childhood Training Alliance.
Signature __________________________________________________________ Date ______________________
Phone : (901) 333-5541
Southwest Tennessee Community College
Memphis, TN 38101
Southwest Tennessee Community College
The TECTA program is funded through a contract with the Tennessee
Department of Human Services and Tennessee State University,
Center of Excellence for Learning Sciences.
Revised 4/2017
Center of Excellence for Learning Sciences w Tennessee State University
TECTA Student Information Form
TECTA Orientation Location or Institution Attending ________________________________________________________
Social Security Number _____ - _____ - _______
Name ________________________________ ________________________ _____________________
Last First Middle
Employment Status
Your Place of Employment _______________________________________________________________________________
Ages of children in classroom (choose one)
o Birth to 8 months o 9 to 17 months o 18 to 36 months o 3 to 5 year olds
o School-Age o Family Childcare
o Mixed-age Group: Infants o Mixed-age Group: Infants and Preschool o Not a Direct Care Provider
TECTA Support Received for: Semester Fall 2019
Salary: Please note: this question is for research purposes ONLY. Individual responses will not be identified or published.
$ ____________ per Hour
Current Position Title: o Asst. Director o Asst. Director/Teacher o Caregiver/Teacher
o DHS Staff o Director o Director/Teacher o Home Visitor
o Home Visitor Supervisor o Other o Owner of Program o Sub/Floater
o Teacher Aide o Authorized o Volunteer
Number of years in current position ________ Number of years in Early Childhood Field _______
Number of years at current place of employment _______ Hours worked per week_____________
Do you have children with diagnosed delays or disabilities in your classroom? o Yes o No
Number of children in your classroom____________
Please complete the next page if you are a first-time TE
CTA-supported student.
Southwest Tennessee Community College
The TECTA program is funded through a contract with the Tennessee
Department of Human Services and Tennessee State University,
Center of Excellence for Learning Sciences.
Revised 4/2017
Center of Excellence for Learning Sciences w Tennessee State University
TECTA Student Information Form
Complete this page if this is th
e first time you are receiving TECTA services.
Please check the professional organization(s) to which you belong:
o Head Start Association o National Association for the Education of Young Children
o National Black Child Development Institute o National Child Care Association
o National Family Child Care Association o Tennessee Association for the Education of Young Children
o Tennessee Family Child Care Alliance o Tennessee School-Age Care Alliance
Highest education level completed before seeking TECTA support
o Less than 9th grade o 9th – 12th grade (no diploma) o High School Graduate/GED
o Some College o Technical Certificate o Associate of Applied Science
o Associate Degree o Bachelors/Baccalaureate Degree o Masters/Doctorate Degree
College or University of Highest Degree ________________________________________________________
Major: o Early Childhood Education o Elementary Education o Special Education
o Other ____________________ Graduation Date of Highest Degree ______/_________
Parents’ Educational Levels
Mother
o Less than 9th grade o 9th – 12th grade (no diploma) o High School Graduate/GED
o Some College o Technical Certificate o Associate of Applied Science
o Associate Degree o Bachelors/Baccalaureate Degree o Masters/Doctorate Degree
Father
o Less than 9th grade o 9th – 12th grade (no diploma) o High School Graduate/GED
o Some College o Technical Certificate o Associate of Applied Science
o Associate Degree o Bachelors/Baccalaureate Degree o Masters/Doctorate Degree
Professional Objectives
Why do you want to participate in TECTA training? (Check all that apply):
o Further my education o Help with my job search o Improve my job skills o Obtain a CDA
o Obtain a raise/higher pay
Have you completed other early childhood training during the last 12 months? o Yes o No
Did your employer require the training? o Yes o No
Do you plan to continue working in child care? o Yes o No
If no, please tell us why_________________________________________________________________________________
NOTICE: If you have changed your name and/or address since you last enrolled in a TECTA-supported course, please fill out a
TECTA Student Change of Information Form and return it as soon as possible to your local TECTA site.
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
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

TA Degree AS (Southwest Tennessee Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document