SUPPORT CENTER APPLICATION PACKET 2015 – 2016 Academic Year PROGRAM ELIGIBILITY REQUIREMENTS To be eligible for the Support Center program your Expected Family Contribution (EFC) as determined on your Free Application for Federal Student Aid (FAFSA) or Texas Application for State Financial Aid (TAFSA).
APPLICATION PROCESS Step 1 – Complete your FAFSA or TAFSA. Step 2 – Print and attach one of the following EFC verification documents. NAIV database printout from the financial aid office. (if you have completed for your FAFSA/TAFSA more than 3-7 days ago) Student Aid Report (SAR) from FAFSA/TAFSA (if applied for financial aid for 2015-2016, but award is unknown) Step 3 – Print and attach the Degree Details from your Degree Map To print your degree detail, go to http://www.austincc.edu/degree-map Step 4 – If requesting child care payment assistance, apply for Workforce Solutions Child Care Services (CCS) and/or other applicable financial assistance.
To apply for CCS, contact Workforce Solutions Capital Area (for Travis County residents) at 512.597.7191 or Workforce Solutions Rural Capital Area (for Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano or Williamson county residents) at 512.260.1937 ext. 4019 or toll free at 1.877.223.0404 ext. 4019
If using Extend-A-Care for after school child care (in Austin ISD, Del Valle ISD, Hays CISD, select Austin charter schools and head start programs), call 512-472-9402 for financial assistance information.
If using YMCA for child care or after-school care call YMCA of Austin at 512-236-9622 or YMCA of Greater Williamson County at 512-615-5563 for financial assistance information.
Step 5 – Submit completed application to your Support Center. To be considered “complete” the student must fill out the entire Support Center Application form except where indicated “To be completed by ACC staff only” and submit all requested supporting documentation. Students who are not eligible to complete the FAFSA or TAFSA can contact a Special Populations Specialist to discuss alternatives. Proof of parentage requirement: If you are awarded Support Center Child care payment assistance, you must provide proof of parentage (such as a birth-certificate or adoption papers) for each child at the time you are awarded funding. To request proof of parentage, visit Texas Vital Statistics at http://www.dshs.state.tx.us/vs/reqproc/vsulocations.shtm
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Revised 04/15
CONFIDENTIAL APPLICATION FOR SUPPORT CENTER SERVICES 2015-2016 ACADEMIC YEAR Applications are accepted year-round. Students, including those who received assistance during 2014-2015, must submit a new application before Thursday July 23rd, 2015 to be considered for fall 2015 assistance. All other eligible applicants are considered in order by date applications are received and as funds are available. For 2015-2016, I am requesting:
Child care payment assistance
Last Name
First Name
Street
Apt. #
Cell phone #
Textbook purchase assistance Student ID#
City
Alternate phone #
Zip
TX
ACC e-mail @g.austincc.edu
Check all that apply: Race/Ethnicity: White Gender:
Male
Female
Black
Hispanic
Asian
Marital Status: Married Single
Check all that apply: Foster Care Alumni (FCA)
Honors
Hawaiian/Pacific Islander
American Indian/Alaskan Native
Do you intend to graduate and/or transfer from ACC?
Student Accessibility Services (SAS)
Veteran
I. CHILD CARE INFORMATION
I
I have applied to the Workforce Solutions Child Care Services (CCS). What is your child(ren)’s status? ______ Waiting List ______ Denied______ Receiving have applied for financial assistance (for Extend-A-Care or YMCA after-school programs only) What is your child(ren)’s status? ______ Waiting List ______ Denied______ Receiving Pre-School Children (Ages 0-5) Needing Child care Child’s name
School-Aged Children (Ages 5-12) Needing Child care Child’s name Age
Age
GO TO NEXT PAGE ---------------- SUPPORT CENTER USE ONLY – DO NOT WRITE BELOW LINE ----------------
Campus: Eligibility Status CURRENT NEW
Date Complete: Household Income $______________
Anticipated Credit Hours Fall 2015
Spring 2016
Summer 2016
Credits
Credits
Credits
EFC $ ______________
CC $
CC $
CC $
Perkins
FPG: Under 150%
TB $
TB $
TB $
Student Life
No. in family ________
Gender Equity: Yes
Original Application Date
Major/Degree Plan: Health Science program, if applicable:
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No
ACAN (circle one)
Austin Partners in Education (APIE)
Breakthrough Austin
Communities in Schools (CIS)
College Forward
Con Mi Madre
KIPP Through College
Hispanic Scholars Consortium
Revised 04/15
II. COURSE INFORMATION
Fall 2015
I plan to register for the following credit hours:
Spring 2016
Summer 2016
# of Credits _____ # of Credits _____ # of Credits _____
READ THIS BEFORE SIGNING BELOW: The Support Center provides customized case management services to eligible students. Services may include assistance paying for child care and textbooks, one-on-one educational and career planning and goal-setting, course selection and follow through to help you reach your academic goals. The amount of childcare and/or textbook assistance you receive is based on the number of approved credit hours for which you are enrolled each semester. Only courses listed on your degree plan will be approved. Check the statements below before signing this application: I am expected to work closely with my campus Support Center Specialist to do the following: Develop and complete my Plan for Achieving Student Success (PASS) goals each semester. Maintain regular contact with my Support Center Specialist as outlined in my PASS goals. Contact my Support Center Specialist any time I experience academic or personal challenges and before I add or withdraw from any course. I understand that my continued Support Center assistance is dependent upon both of the following: Active participation each semester to meet the expectations listed above, and Satisfactory progress each semester in reaching educational goals outlines on my PASS form. I certify that all the information on this application is correct.
Signature: __________________________________________________ Date: _____________________
SUBMIT THIS FORM AND REQUIRED ATTACHMENTS TO YOUR CAMPUS SUPPORT CENTER. Cypress Creek
Eastview
Elgin
Hays
Highland
C. Marshall Bennett
Angelica Cancino
Patricia Sanchez
Alegra Harris
Roseana Lahti
512-223-2205
512-223-5214
512-223-9408
512-262-6530
512-223-7344
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Northridge
Pinnacle
Riverside
Round Rock
South Austin
Lauren Gage
Joyce Pope Cain
Linda Lujan Reister
Stephanie Horgan
Michael Gibbs
512-223-4845
512-223-8111
512-223-6026
512-223-0032
512-223-9161
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
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Revised 05/15
