T.E.A.C.H. Early Childhood Rhode Island Scholarship Application Associate s Degree. Employed Directors and Owner/Operator Directors AED/AO Models

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1 Page 1 of 9 T.E.A.C.H. Early Childhood Rhode Island Scholarship Application Associate s Degree Employed Directors and Owner/Operator Directors AED/AO Models Date: 1. Name: 2. Address: County: City: State: Zip: _ Mailing Address (if different) 3. Telephone: Home ( ) Cell ( ) _ 4. Address: 5. Social Security #: 6. Birth Date: _ Gender: 7. CCRI College Student ID # (if applicable) 8. Employment Status a. Program Name: City:_ b. Center Phone Number: What is your current job title? What age children does your center enroll? (please check all that apply) Director (Employed) Assistant Director (Employed) Owner/Operator Specify Title: Infants (0-12 Months) Toddler (13-36 Months) Non-Teaching Professional Staff Non-Teaching Support Staff Other (specify) _ Preschool (37 Months PreK) School Age (full time school age not an option in Rhode Island) How many children are in your center? How many hours per week do you work? How many hours per week do you spend completing administrative tasks? How many months per year do you work? Beginning date of employment at current facility? What is your current hourly wage? How long have you worked in the field of early childhood? Less than 2 Years 2-5 Years 6-10 Years 10+ Years

2 Page 2 of 9 9. Ethnicity Are you of Hispanic, Latino or Spanish origin? No Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Cuban Other Hispanic, Latino or Spanish Do you consider yourself.? White Black, African Am. Or Negro American Indian or Alaska Native Asian Indian Japanese Native Hawaiian Chinese Korean Guamanian or Chamorro Filipino Vietnamese Samoan Other Asian: _ Other Pacific Islanders: _ Other race: _ 10. How did you hear about the T.E.A.C.H.? Early Childhood Project? Presentation Mailing CCR&R Agency College My Center T.E.A.C.H. Recipient Workshop Website Other (please specify): _ 11. Educational History and Goals: a. Please check the box that best describes your educational history: No high school diploma High school diploma/ged Some college work 1-year certificate Associate s Degree (Major: _) Bachelor s Degree (Major: ) Master s (Major:) Doctorate b. Please check one that best describes your educational goals: Earn an Early Childhood or School-Age Credential Take a few early childhood courses to obtain or upgrade job-related skills Earn an Early Childhood, Infant/Toddler or School-Age Certificate Earn an Early Childhood Associate s Degree Earn an Early Childhood Associate s Degree and transfer to a four-year college/university to earn a Bachelor s Degree

3 Page 3 of 9 c. Are you currently enrolled at a community college? Yes College Name No What is your major or program? _ d. When would you like your scholarship to begin? (Circle one and identify starting year) FALL SPRING SUMMER (year) e. If awarded a scholarship what campus would you like to attend? Community College of Rhode Island Liston-Providence Knight -Warwick Flanagan - Lincoln Newport Westerly Satellite f. Educational Information (Attach transcripts for all college courses you have taken. Unofficial transcripts are acceptable.) College/ University Dates Attended Degree or Credit Hours g. Do you have a current CDA Credential? Yes No h. Are you within 8 courses of graduating? Yes No

4 Page 4 of What are your short and long term professional goals in early childhood education? 13. Please provide any additional information you would like us to consider as we review your application.

5 Page 5 of 9 T.E.A.C.H. Early Childhood Rhode Island Statement of Income Job #1 Employer Hours/Week _ Earnings per Job #2 Employer Hours/Week Earnings per Have you applied for any other financial aid through FAFSA (www.fafsa.ed.gov) or other sources? YES NO Source of financial aid #1 Date of application Application Status: AWARDED DENIED PENDING Source of financial aid #2 Date of application Application Status: AWARDED DENIED PENDING YOUR TOTAL GROSS ANNUAL INCOME $_ YOUR TOTAL FAMILY GROSS ANNUAL INCOME (your spouse included) $ STATEMENT & SIGNATURE OF APPLICANT I attest to the fact that the information that I have provided is true and accurate. Based on this information I am applying to T.E.A.C.H. Early Childhood Rhode Island for a scholarship to help pay the cost of educational expenses. T.E.A.C.H. Early Childhood Rhode Island is a project of Ready to Learn Providence and The Providence Plan. Signature of Applicant Date PLEASE ATTACH A COPY OF YOUR MOST RECENT PAY STUB HERE. All applicable financial aid letters should also be included with the application packet.

6 Page 6 of 9 DIRECTOR ASSOCIATE S PROGRAM PARTICIPATION AGREEMENT AED/AO Models The T.E.A.C.H. Early Childhood Rhode Island associate s degree scholarship program requires active participation and cost sharing from each scholarship recipient. In the event that I am awarded a scholarship, I agree to the following participation requirements: 1. Remain enrolled in an associate s degree program in the major of early childhood education/child development at the Community College of Rhode Island. 2. Employed Directors: Upon receipt of semester bills from T.E.A.C.H. employed directors personally pay 7.5% of outstanding tuition and associated fees for approved courses. The program matches an additional 7.5%. Owner/Operator Directors: Upon receipt of semester bills owner/operator directors pay a total of 20% of outstanding tuition and associated fees for approved courses. 3. Pay 10% of the cost of required books for each approved semester and for approved courses. There are no book co-pays for programs. 4. Successfully complete a minimum of 9 credit hours of coursework and no more than 15 credits at the Community College of Rhode Island during a twelve month contract period. 5. Remain in the employ of the sponsoring program or agree to keep the program open for one full year following the end of each approved contract period. 6. Submit evidence of a completed FAFSA form at the time of application and every spring thereafter during years of T.E.A.C.H. participation. Receipt of financial aid is not required to receive a T.E.A.C.H. Scholarship. However all applicants are required to apply for federal, state, and college aid via the completion of a FAFSA form. FAFSA stands for Free Application for Federal Student Aid. FAFSA forms can be accessed and filed through the website Be sure to access the given website, similar web addresses unnecessarily charge money for processing. The site you are referred to is free. If you have questions about this process, or need help completing the online FAFSA form, please contact the Educational Opportunity Center at CCRI, Due to the award cycles of FAFSA, it may be necessary for new T.E.A.C.H. summer applicants to apply for FAFSA two times within one T.E.A.C.H. contract period. 7. I understand that I will receive a $50 travel stipend each semester I take courses as a T.E.A.C.H. scholar. I understand that upon successful completion of my contract I will also receive a $585 annual bonus from T.E.A.C.H. 8. Owner/Operator Directors agree that application listed work hours directly correspond to child care program related duties, for example staff support and supervision, curriculum development, budgeting, and scheduling. Hours spent on non-child care program tasks cannot be counted as T.E.A.C.H. hours. Signature of T.E.A.C.H. Scholarship Applicant Date Please Print Name

7 Page 7 of 9 T.E.A.C.H. Early Childhood Rhode Island Early Childhood Associate s Degree Scholarship Project AED/AO Model Center Participation Agreement Page 1 This agreement must be completed by the center director, and the center owner or board chairperson. The T.E.A.C.H. Early Childhood associate s degree scholarship program, a project of Ready to Learn Providence and The Providence Plan, requires the participation of each scholarship recipient s employing child care center. In the event that is awarded a scholarship, I understand that the center agrees to participate (Applicant Name) in one of the following ways. _ Associate s Employed Director s - (AED-1) 1. Center pays 7.5% of the cost of tuition and associated fees for 9-15 credits at the Community College of Rhode Island. 2. Upon successful completion of 9-15 credit hours, the submission of all required paperwork and at the end of the contract, T.E.A.C.H. will award one $585 bonus to employed directors. On the contract end date the center will increase the employed director s salary by 1.5% beyond any raise normally expected. 3. No release time is given under the terms of the director model scholarship. _ Associate s Employed Director s - (AED-2) 1. Center pays 7.5% of the cost of tuition and associated fees for 9-15 credits at the Community College of Rhode Island. 2. Upon successful completion of 9-15 credit hours, the submission of all required paperwork and at the end of the contract, T.E.A.C.H. will award one $585 bonus to employed directors. The center will be responsible for an additional bonus of $200 to be paid by the mid-point of the commitment year. 3. No release time is given under the terms of the director model scholarship. Owner/Operators Director s Model- (AO) 1. Owner/Operator Administrator pays 20% of the cost of tuition and associated fees for 9-15 credits at the Community College of Rhode Island. 2. At the end of the contract and upon completion of 9-15 credit hours, T.E.A.C.H. will award a $ bonus. The center will not be responsible for any additional bonus. 3. No release time is provided under the terms of the director model scholarship. Center Auspice: Profit _ Non-profit _ BrightStars Rating: 1 _2 _3 _4 _5_ Candidate Name for this contract: _ Number of hours candidate works per week: Months worked per year: Hourly rate of pay: We the undersigned agree to the terms indicated in the above T.E.A.C.H. Center Participation Agreement. (Please print name of Director) (Signature of Director) (Date) (Please print name of Chairperson/Owner) Is your center accredited? Yes_ No_ If yes, by whom? _ Does your facility accept children with DHS subsidy? Yes No What percentage of your enrollment receives DHS Subsidy? Is this child care program owned or managed by another organization: Yes No If yes, give the parent company name/address: (Signature of Chairperson/Owner) (Date) *Two signatures are required in all circumstances. This requirement applies to all programs including when a director and the owner are the same person or a program is a Head Start or Community Action program. If there is a Board, a Board Member signature is required.

8 Page 8 of 9 T.E.A.C.H. Early Childhood Rhode Island Early Childhood Associate s Degree Scholarship Project Center Participation Agreement - Page 2 Program Name: _ Phone # Physical Address of Program _ Center Mailing Address (if different from physical address) Center Address: Program Fax #: DCYF Provider ID #_ License # Program Tax identification # License Capacity: Present Enrollment: _ Name and position of the administrator who should receive T.E.A.C.H. approval and billing information Address of above administrative contact person Phone number of administrative contact person address Name and of site director if different than above (Please print information) Please check all forms of funding your facility receives: Head Start Title 1 Early Head Start Idea State Head Start State Subsidies: Contracts State Pre-K State Subsidies: Vouchers

9 Page 9 of 9 T.E.A.C.H. Scholarship Application Checklist T.E.A.C.H. Center-based Associate s Candidates: I have applied to CCRI. Applications are available at Previous degree students who have not taken courses in the last two years must apply for readmission. An admission application submitted online is free; submitted paper applications have a fee of $20.00, payable to CCRI. I have included an admission letter of acceptance, or a CCRI transcript that shows proof of recent enrollment. My submitted letter of acceptance or current transcript indicates that my declared major is Early Childhood Education/Child Development. Students who have an alternate major must change their major through contact with the College s Office of Enrollment Services. I have completed Accuplacer tests and had my scores and course placement information faxed to the T.E.A.C.H. Scholarship Project Office (Attention: Maura Pearce or Samantha McCormack ). The Accuplacer test assesses proficiency in English, math, and reading. Tests may be arranged through CCRI s Department of Advising and Counseling (information below). For scores to be sent to T.E.A.C.H. you must indicate to the CCRI testing center that you are applying for a T.E.A.C.H. scholarship. A practice Accuplacer test is available at I have paid any outstanding balance/bills owed to the Community College of Rhode Island (CCRI) and to any other colleges I attended. I understand that I will not be allowed to register for classes if I owe any money to CCRI. Balances owed to other colleges or defaulted student loans may also impact enrollment. I have completed all information and signed and dated the application. I have submitted a copy of transcripts for all college courses I have taken. (Unofficial transcripts are acceptable.) I have submitted verification of income from all my current places of employment (e.g. recent paystub). I have had the Director and Owner of my center, and as applicable, a member of the Board sign the T.E.A.C.H. Center Participation Agreement in the scholarship application. The Center Participation Agreement must have two signatures even if the signing administrator and owner is the same person. I have submitted a current copy of my program s DCYF license. I have completed a FAFSA form (Free Application for Federal Student Aid) form. Consult for filing information. (The provided FAFSA site is free. Beware of similar sites that cost money!) I have submitted verification that I have completed the FAFSA process successfully. I have included a copy of any notice or an award or denial of aid. (T.E.A.C.H. applicants must complete the FAFSA process. However, receipt of financial aid through FAFSA is not required.) Return Application and Required Documentation to: T.E.A.C.H. Early Childhood Scholarship Project Ready to Learn Providence 945 Westminster Street Providence, Rhode Island If you have any questions, please call Maura Pearce or Samantha McCormack at Community College of Rhode Island To arrange for accommodations Department of Advising and Counseling regarding disabilities, call: Warwick Warwick Lincoln Lincoln Providence Providence Newport Newport For assistance in completing FAFSA forms, contact a CCRI Educational Opportunity Center: Providence, Warwick, Lincoln ; Newport

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