Walters State Forms
DCEA CCAMPIS Grant Application
Child Care Grant Information
I certify I have read the document above.
To be eligible for this grant, students must meet the following requirements.
Check all applicable Eligibility Requirements:
• Must have eligible dependent child(ren) – infants through preschool or in an afterschool program.
• Must complete the Free Application for Federal Student Aid (FAFSA), and be Pell-eligible.
• Must be enrolled in a degree program at Walters State.
• Must be enrolled in at least six (6) credit hours per semester.
Priority will be given to students who meet at least one of the following priorities. (please check all that apply)
single parent
veteran
Low-income students with the greatest financial need
Enrolled at WSCC with full-time status of 12 credit hours or more
Students with good academic standing - Cumulative grade point average of 2.5 or above.
Name
(required)
Email
(required)
Address
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Cell Phone
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2nd phone number
W#
(required)
Date of Birth
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Gender
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Male
Female
Race
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Black or African American
White
Asian
American Indian
Alaskan Native
Native Hawaiian or other Pacific Islander
Do you consider yourself to be Hispanic, Latino, or of Spanish Origin?
(required)
No
Yes
Marital Status
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married
single
divorced
widowed
separated
Enrollment Status
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full time
part time
Number of hours completed (from previous question)
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Program of Study
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Number of children you are needing assistance for
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Child’s first name or nickname and date of birth ( (please place each child on a new line in the box below)
(required)
Which campus will you be attending
(required)
Morristown Campus
Claiborne County Campus
Sevierville Campus
Greeneville/Niswonger Campus
Newport Center
Are you currently employed
(required)
Yes
No
if yes, (previous question), please choose an option below:
full time
part time
Annual income
(required)
Please explain why you are applying for this grant and include any special circumstances of financial need you may have
Have you been accepted to WSCC?
(required)
No
Yes
Have you completed the FAFSA?
(required)
Yes
No
What is your parents' highest level of education? (highest for both parents collectively)
(required)
Elementrary
High School
Vocational School
College
County of residence
(required)
Please Understand, if approved to receive this grant, there is a requirement to participate in a CAMPIS Childcare Grant Orientation during your first semester of CCAMPIS entry. Verify this understanding by clicking yes or no.
(required)
No
yes
Please Understand, if approved to receive this grant, there is a requirement to meet with your CCAMPIS Specialist at least twice per semester. Verify this understanding by clicking yes or no.
(required)
No
yes
Please Understand, if approved to receive this grant, there is a requirement to participate in at least one workshop, seminar, or parenting activity per semester. Verify this understanding by clicking yes or no.
(required)
No
yes
Please Understand, if approved to receive this grant, additional requirements include signing a childcare grant agreement, following childcare center policy, regularly attending classes, meeting once per semester with your academic advisor, and remaining in good academic standing. Verify this understanding by clicking yes or no.
(required)
No
yes
By typing your name below, you acknowledge that all information you have submitted in this form is correct and this will be used as an electronic signature.
Signature (type your full name please):
(required)
