TECTA Tuition Assistance Checklist for First Semester CDA Seeking Students

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1 737 Union Avenue Memphis, TN P: (901) F: (901) TECTA Tuition Assistance Checklist for First Semester CDA Seeking Students 1. Complete Southwest Admissions Application at When asked for application type, you need to choose not trying to earn a degree from the drop down menu in the application. If you check anything else, it will delay admission because you will be required to provide transcripts and take the Compass Placement test. You will need to pay the $10 application fee by credit or debit card at the time of application. If you need to pay by cash or check, you can take it to the Cashier s office on Union or Macon. If you need help or access to a computer, the registration lab is in M-107. You may call to see if your application has been processed or you may attempt to log on to If your application has been processed you will be able to log in to the portal on the left. 2. Once your Admissions Application has been processed (takes about 1 week), you need to attend a Southwest New Student Orientation (face to face or online). For dates and times call After you are admitted and complete the New Student Orientation, you register for classes. You may register online on your own or use the registration lab located in M 107. You need to register for 2 classes: ECE 2310 (Safe Healthy Learning Environments) and ECE 2335 (Initial Practicum). 4. Once you have registered for classes, complete the checklist below. You may turn in the documents listed below to the TECTA office at the same time you complete your admissions application. Completed Application for Academic Financial Support for ECED 2310 and another copy of the Application for Academic Financial Support for ECE 2335 Student Information Form Student Request to Share Information Copy of your Fall 2015 course schedule Copy of check stub as proof of employment in a licensed early childhood program Tuition Payment Information: The student portion of fees for ECE 2310 and 2335 is $100. You may pick up your payment voucher in the TECTA office or call the office ( ) and request it be mailed to you. TECTA cannot make a scholarship payment until you 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 1, 2015 for early registration by 3:00 pm on the day of registration during regular registration. 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. Student Signature

2 Application for Academic Financial Support Tennessee Early Childhood Training Alliance P O Box 780 Memphis, TN 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 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 ( ) Eligibility Phone : (901) 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, Center of Excellence for Learning Sciences. Center of Excellence for Learning Sciences Revised 12/17/2013 Form: TECTA Tuition Assistance Request

3 Application for Academic Financial Support Tennessee Early Childhood Training Alliance P O Box 780 Memphis, TN 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 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 ( ) Eligibility Phone : (901) 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, Center of Excellence for Learning Sciences. Center of Excellence for Learning Sciences Revised 12/17/2013 Form: TECTA Tuition Assistance Request

4 Student Information Form P O Box 780 Memphis, TN Phone : (901) 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 School Age Mixed Age Group 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 Center of Excellence for Learning Sciences Revised 12/16/2013 Form: TECTA Student Information

5 Complete this portion only the first time you receive TECTA services Highest educational achievements before seeking TECTA support < 9 th grade 9 th 12 th 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 th grade 9 th 12 th grade (no diploma) High School Graduate/GED some college certificate Associate Baccalaureate Masters/Doctorate Father < 9 th grade 9 th 12 th grade (no diploma) High School Graduate/GED ome college certificate 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. Center of Excellence for Learning Sciences Revised 12/16/2013 Form: TECTA Student Information

6 Student Request to Share Information Office of Admission and Records 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 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 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: Address: _Elizabeth O. Wilson, Southwest -TECTA Director P.O. Box 780 Memphis, TN (901) Student s Signature Date

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