T.E.A.C.H. Early Childhood Rhode Island Scholarship Application Associate s Degree

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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 or Employed Assistant Directors AED Model Owner/Operator Directors AO Model 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 #: 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) n-teaching Professional Staff n-teaching Support Staff Other (specify) _ Preschool (37 Months PreK) School Age -full time school age directors not eligible for RI scholarship 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, Race, and Language Are you of Hispanic, Latino or Spanish origin? 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: _ Which languages can you speak fluently? Arabic Armenian Chinese Creole English French Greek Hindi Japanese Korean Lao Persian Polish Portuguese Russian Spanish What is your preferred language for learning? _ Swahili Thai Tribal: Urdu Vietnamese Yiddish Other: 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: high school diploma High school diploma/ged 1-year certificate CDA Type: Some College Coursework Master s Degree b. Please check one that best describes your educational goals: Associate s Degree (Major: _) Bachelor s Degree (Major :_) (Major: ) Doctorate Degree 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 What is your major or program? _ d. Have you taken any college courses in the past two years? Yes e. Have you taken any ECE credits in the past two years? Yes how many? f. Are you CPR/First Aid Certified? Yes g. When would you like your scholarship to begin? (Circle one and identify starting year) FALL SPRING SUMMER (year) h. If awarded a scholarship what campus would you primarily like to attend? (Campus coursework can be mixed.) Community College of Rhode Island Liston-Providence Knight -Warwick Flanagan - Lincoln Newport Westerly Satellite i. Educational Information Attach transcripts for all college courses you have taken. Unofficial transcripts are acceptable. College/ University Dates Attended Degree or Credit Hours j. Are you within 8 courses of graduating? Yes FOR NATIONAL STATISTICAL PURPOSES PLEASE ANSWER THE FOLLOWING: k. How many people live in your household? Number Relationship Parents Siblings Spouse/Significant Other Children Other l. Have either of your parents or any of your brothers or sisters attended college? Yes m. Do either of your parents or any of your brothers or sisters have a college degree? Yes

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 ( 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/ASSISTANT DIRECTOR ASSOCIATE S SCHOLAR PARTICIPATION AGREEMENT 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 Director/Assistant Director: Upon receipt of semester bills from T.E.A.C.H. employed directors/assistant 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 9-15 credit hours at the Community College of Rhode Island during contract period that will not exceed 12 months. 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. (See application checklist for filing information.) 7. Submit course registration material to T.E.A.C.H. within one month after the opening of each registration period. Typically registration for fall and summer terms opens in April. Registration for spring semester courses opens in vember. (Exceptions to these dates are in place for a scholar s first term.) Book claims are due within one month after a semester start. Due to funding cycles, release time claims must be submitted within two weeks after the close of a semester. 8. 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 and after all final paperwork is submitted and approved I will also receive a $585 annual bonus from T.E.A.C.H. 9. 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. 10. I understand this contract is contingent on the continuing availability of funds. College tuition payments, as well as claim reimbursements and bonus compensation to scholars and/or sponsors, scheduled for dates past 12/31/15, will be paid only if an extended contract and approved purchase order is signed between Ready to Learn Providence, a program of The Providence Plan, and the State of Rhode Island for the period of 1/1/16 through 9/30/16. Without such an agreement this contract will terminate on 12/31/15. T.E.A.C.H. hopes to have notification of a new funding award by vember Upon receipt of notice T.E.A.C.H. will notify scholars and sponsors. 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 Associate s Degree Scholarships for Directors/Assistant Directors AED/AO Models 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 model offered through T.E.A.C.H. Early Childhood Rhode Island, a project of Ready to Learn Providence and The Providence Plan, requires the participation of each scholarship recipient s employer. In the event that is awarded a scholarship (Applicant Name) the center agrees to participate in one of the following ways. Check desired model category.. I/We understand this contract is contingent on the continuing availability of funds. College tuition payments, as well as claim reimbursements and bonus compensation to scholars and/or sponsors, scheduled for dates past 12/31/15, will be paid only if an extended contract and approved purchase order is signed between Ready to Learn Providence, a program of The Providence Plan, and the State of Rhode Island for the period of 1/1/16 through 9/30/16. Without such an agreement this contract will terminate on 12/31/15. T.E.A.C.H. hopes to have notification of a new funding award by vember Upon receipt of notice T.E.A.C.H. will notify scholars and sponsors. release time is given under the terms of any director model scholarship. _ Associate s Employed Director/Assistant Director Model- (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 the employed director/assistant director. On the contract end date the center will increase the employed administrator s salary by 1.5% beyond any raise normally expected. 3. The approved scholar administrator works more than 50% of work week as a non-teaching administrator. _ Associate s Employed Director/Assistant Director Model - (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 the employed director/assistant director. The center will be responsible for an additional bonus of $200 to be paid by the mid-point of the employment commitment year. 3. The approved scholar administrator works more than 50% of work week as a non-teaching administrator. Owner/Operators Director 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, after submission of all required paperwork, 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. Center Auspice: Profit _ n-profit _ 3. 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. (Two signatures required (Please print name of Director) (Signature of Director) (Date) (Please print name of Chairperson/Owner) Is your center accredited? Yes If yes, by whom? _ Does your facility accept children with DHS subsidy? Yes What percentage of your enrollment receives DHS Subsidy? Is this child care program owned or managed by another organization: Yes If yes, give the parent company name/address: (Signature of Chairperson/Owner) (Date)

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: _ Site Phone #: Center Mailing Address: _ Physical Address: (if different from mailing): Program Address: Program Fax #: DCYF Provider ID # License # (Provider ID# appears at the bottom left of license) License Capacity: Present Enrollment: Program /Provider Taxpayer Identification #: Name and position of the administrator who should receive T.E.A.C.H. approval and billing information _ Mailing address of above administrative contact person / Phone number of above administrative contact person address / Name of site director if different than above administrator address 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 Applications must be submitted with the following items: 1) Verification of candidate s income (paystub or letter from sponsoring center showing hourly wage) 2) Copy of the program s current DCYF license 3) Evidence of completion of FAFSA (financial aid form) for scholar 4) Two signatures in the box on page 7 of the center participation agreement. Return Applications to: T.E.A.C.H. Early Childhood Rhode Island Ready to Learn Providence 945 Westminster Street, Providence, Rhode Island If you have any questions, please contact Maura Pearce or Samantha McCormack at (401)

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 required Accuplacer tests and have had my scores and course placement information faxed to the T.E.A.C.H. Scholarship Project Office at (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). 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 application 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(s). 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.) 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 Due to 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. Although the EOC office is located on the campus of the Community College of Rhode Island, the EOC services students from all colleges. 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

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