SUPPORT CENTER APPLICATION PACKET 2016 – 2017 Academic Year PROGRAM ELIGIBILITY REQUIREMENTS Eligibility for the Support Center program depends on your Expected Family Contribution (EFC) as determined on your Free Application for Federal Student Aid (FAFSA) or Texas Application for State Financial Aid (TASFA). Students who are not eligible to complete the FAFSA or TASFA can contact a Special Populations Specialist to discuss alternatives.
APPLICATION PROCESS Step 1 – Complete your FAFSA or TASFA. Step 2 – Print and attach one of the following EFC verification documents. NAIV database printout from the financial aid office (if you completed your FAFSA/TASFA more than 3-7 days ago) Student Aid Report (SAR) from FAFSA/TASFA (if applied for financial aid for 2016-2017, 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, you must also 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. 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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CONFIDENTIAL APPLICATION FOR SUPPORT CENTER SERVICES 2016-2017 ACADEMIC YEAR Applications are accepted year-round. Students, including those who received assistance during 2015-2016, must submit a new application before Thursday, July 21, 2016, to be considered for Fall 2016 assistance. All other eligible applicants are considered in order by the date applications are received and as funds are available. Child care payment assistance
For 2016-2017, I am requesting: 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
Married: Yes
Hispanic
No
Asian
Children: Yes
Hawaiian/Pacific Islander
No
American Indian/Alaskan Native
Do you intend to graduate and/or transfer from ACC?
Check all that apply: Foster Care Alumni (FCA) Honors Student Accessibility Services (SAS) Veteran
ACAN/AOYC First Gen. In College
I. CHILD CARE INFORMATION
I have applied to the Workforce Solutions Child Care Services (CCS). What is your child(ren)’s status? ______ Waiting List ______ Denied______ Receiving
I 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
Anticipated Credit Hours
Date Complete: Household Income $ _____________
Original Application Date
EFC $ ______________ Perkins
Mitte
Student Life Major/Degree Plan:
FPG: Under 150% No. in family ________ Gender Equity: Yes
Health Science program, if applicable:
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No
Fall 2016
Spring 2017
Summer 2017
Credits
Credits
Credits
CC $
CC $
CC $
TB $
TB $
TB $
ACAN
Austin Partners in Education (APIE)
Breakthrough Austin
College Forward
Communities in Schools (CIS)
Con Mi Madre
KIPP Through College
Hispanic Scholars Consortium
(circle one)
AOYC (circle one)
American Youthworks
Communities in School (CIS)
Goodwill Central Texas
Lifeworks
Workforce Solutions
Revised 04/16
II. COURSE INFORMATION
Fall 2016
I plan to register for the following credit hours:
Spring 2017
Summer 2017
# 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. Initial 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 _____ Contact my Support Center Specialist 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 outlined on my PASS form. I certify that all of 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
512-223-9415
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
Eriko Tyner
Stephanie Horgan
Michael Gibbs
512-223-4845
512-223-8111
512-223-0032
512-223-9161
[email protected]
[email protected]
[email protected]
[email protected]
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512-223-6026
[email protected]
Revised 04/16
