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CCAMPIS Application

Please carefully read and complete the following form and submit. Please contact us at UD-ELC@udel.edu with any questions.

Have you previously completed and submitted this application?

Yes

Thank you for your interest in the ELC CCAMPIS Program. If you have already submitted your application, there is no need to resubmit. Should there be any updates to your submitted information, please contact us at ud-elc@udel.edu.

Eligibility Guidelines for the CCAMPIS Program

Undergraduate students must be receiving a Pell Grant or be Pell Grant eligible based on the Expected Family Contribution. A FAFSA must be completed and on file with the University of Delaware Office of Financial Aid.(Required)

I Understand

Graduate/Professional students who are enrolled full time at University of Delaware (UD) may be eligible to receive CCAMPIS assistance pending verification of eligibility and Expected Family Contribution on the FAFSA report.(Required)

I Understand

I need to take a summer course in order to maintain continuous enrollment for my child at the ELC.(Required)

I Understand

The link for the free application for the FAFSA is https://studentaid.gov/h/apply-for-aid/fafsa. Please complete using the institutional code for the University of Delaware, 001431. This needs to be completed and on file with UD for CCAMPIS application to be considered.(Required)

I Understand

Child care services for the University of Delaware CCAMPIS program must be provided at the UD Early Learning Center (ELC) and is contingent on space availability.(Required)

I Understand

Child Information

Child's Name(Required)

First Last

Child's Age(Required)

Child's Date Of Birth(Required)

MM slash DD slash YYYY

Child's Sex(Required)

Child's Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Home Phone(Required)

Email(Required)

Date you would like full time enrollment to begin if space is available(Required)

MM slash DD slash YYYY

Please note part time care is not available.

This child will qualify for Purchase of Care.(Required)

Yes

Purchase of Care is a state financial assistance program to help parents meeting income criteria with childcare so the caretaker can hold a job, obtain training, or meet the special needs of an immediate family member. Additional information can be found at the Delaware Department of Health and Social Services’ website – https://dhss.delaware.gov/dhss/dss/childcr.html

This child has a diagnosed disability and an active IFSP (Individual Family Service Plan) or IEP (Individual Education Plan).(Required)

Yes

Diagnosis:(Required)

Services Recieved:(Required)

Does this child have any siblings currently enrolled at the ELC?(Required)

Yes

If yes, please provide names & ages of siblings on next line.

Sibling Names & Ages(Required)

UD Student Parent/Guardian A Information

UD Student Parent/Guardian A(Required)

First Last

Relationship to Child(Required)

UD ID Number(Required)

Is UD Student Parent/Guardian A's address same as child's?(Required)

Yes

Address if different from child(Required)

Street Address City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone(Required)

Email(Required)

Name Of Employer(Required)

Work Phone(Required)

UD Parent/Guardian A's School Information

College(Required)

Major(Required)

Current Student Status(Required)

Undergraduate

Master’s Degree

PhD

Expected Graduation Date (MM/YYYY)(Required)

Cumulative Credits to Date(Required)

Current Enrolled Credits(Required)

GPA Current(Required)

GPA Cumulative(Required)

Have you completed a FAFSA form for the current academic year?(Required)

Yes

Are you currently receiving a Pell Grant?(Required)

Yes

Household Status(Required)

Married

Not married and dependent on UD student’s parents

Not married and independent of UD student’s parents

How did you learn about the CCAMPIS opportunity?(Required)

Is there anything else you would like us to know about your child or application?

Parent/Guardian B Information

If Parent/Guardian B is not applicable please enter “N/A” into the application form for those responses.

Parent/Guardian B(Required)

First Last

Is Parent/Guardian B also a UD Student?(Required)

Yes

Parent/Guardian B's UD ID Number(Required)

Is Parent/Guardian B's address same as child's?(Required)

Yes

Address if different from child(Required)

Street Address City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone(Required)

Email(Required)

Name of Employer(Required)

Work Phone(Required)

Are any of the child's parents active members of the military?(Required)

Yes

CCAMPIS Letter of Agreement

In order to receive the CCAMPIS grant assistance for child care services, ALL CCAMPIS recipients must complete all program requirements within the academic year in order to continue receiving services. Please initial that you have read, understand and agree to the following

I understand that the goal of the CCAMPIS program is the assist me with child care expenses so that I can remain enrolled at UD, and persist towards earning my degree.(Required)

I Understand

My participation in the program is dependent upon my successful completion of semester credits on a consistent basis towards earning my degree.(Required)

I Understand

If I drop classes during any given semester and fall below full-time status, I agree to contact the CCAMPIS Family Support Specialist immediately.(Required)

I Understand

I understand I am immediately responsible for 100% of all child care fees charged by the center if I withdraw as a student from UD.(Required)

I Understand

I understand that there will be ongoing evaluation of the CCAMPIS program and I will have opportunities to participate and share feedback.(Required)

I Understand

I understand I am required to meet with the CCAMPIS Family Support Specialist at least once for orientation and a child and family needs assessment.(Required)

I Understand

I understand and give permission for the UD Early Learning Center to access my personal financial and academic information through the UD Student Financial Aid and Registrar’s Office to determine eligibility for enrollment in the CCAMPIS program.(Required)

I Understand

I understand that aggregate information, but no personal information, will be shared with the U.S. Department of Education in Washington D.C., which funds this program.(Required)

I Understand

I agree to complete a post UD graduation survey, even after my child is no longer receiving services at the ELC pertaining to program evaluation including but not limited to my employment, income, and quality of care/services.(Required)

I Understand

I have read and understand the attached guidelines and hereby certify that the information in this application is complete and accurate to the best of my knowledge. I understand and accept the obligations of the program and will provide a written report to the CCAMPIS Family Support Specialist of any changes in the information provided on this application within 10 days of the change. If I do not, I understand that I am financially responsible for all child care tuition costs charged by the Early Learning Center. Changes may include, but are not limited to my UD enrollment, credit hours, and UD financial aid status.(Required)

I Agree

RIGHT TO KNOW NOTICE

Under the Delaware Code you are entitled to inspect, at any time, the active record and complaint files of any licensed childcare facility. To review a childcare facility record, contact: Office of Child Care Licensing 3411 Silverside Road Concord Plaza Hagley Building Wilmington, DE 19810 302-832-5822. You may also view substantiated complaints and compliance review histories by visiting the Office of Child Care Licensing’s child care search at https://education.delaware.gov/families/occl/child_care_search/.

Right To Know Notice(Required)

I acknowledge that I have received notice of a Parents Right to Know as part of the application packet of materials from the University of Delaware Early Learning Center.

Consent(Required)

I understand that while this application places my child’s name on the ELC waitlist, it does not guarantee enrollment for my child on a specific date.

Child's Name(Required)

First Last

Parent/Guardians Signature(Required)

First Last

Date(Required)

MM slash DD slash YYYY