DCC-202Commonwealth of Kentucky

(R. 11/15/12) Cabinet for Health and Family Services

Department for Community Based Services

Division of Child Care

CDA Scholarship Application

Please return Sections A& B only, by mail to: Hallie Smith, 525 Scott St. Covington, KY 41011

Or Fax to my attention to: 859-442-1622.

If you fax, include a Cover Sheet addressed to Hallie Smith.

Applications are accepted on a first-come, first-serve basis.

The Commonwealth Child Care Credential /Child Development Associate Credential

Scholarship Program

Application

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Program Information

Description: The Commonwealth Child Care Credential/Child Development Associate Credential Scholarship Program is administered by the Cabinet for Health and Family Services, Department for Community Based Services, Division of Child Care. The program provides financial assistance; to the extent funds are available, in the form of scholarships for scholars seeking the Commonwealth Child Care Credential and the Child Development Associate Credential. Scholars must complete all CCCC and CDA training with a 24-month period. This scholarship program shall not be used in conjunction with any other KIDSNOW scholarship program, (moved to stand alone comment)

Eligibility Criteria: An applicant must:

  1. be a Kentucky resident and a citizen, national, or permanent resident of the United States
  2. prior to enrollment, be employed at least 20 hours weekly in a Participating Early Childhood Facility, as defined in 11KAR 16:001; and meet all Child Care licensing or certification requirements for employment as outlined in 922 KAR 2:110 or 922 KAR 2:100
  3. not be eligible to receive state or federal training funds through Head Start, a public preschool program, or First

Steps

  1. commit to providing required services as outlined below (see Service Commitment)
  2. submit the scholarship application by the deadline to the professional development counselor
  3. complete an application for each 60 hours of instruction; and
  4. have a high school diploma or equivalent to apply for a CDA (or to meet employment requirements in 922 KAR 2:110 or 922 KAR 2:100 if applying for a CCCC).

Selection Process: Initial scholarship offers shall be made to all eligible applicants on a first-come first-served basis until appropriated funds are exhausted. Scholarships awarded for a CCCC, or the first 60 hours, does not guarantee eligibility for a CDA (120 hours) Scholarship.

Award Amount: The scholarship amount awarded on behalf of an eligible applicant shall be $210.00 for the Commonwealth Child Care Credential, (Term 1) and $210.00 for the Child Development Associate Credential, (Term 2); the total amount not to exceed $420.00.

Approval and Disbursement Process: Prior to approval,the Professional Development Counselor shall submit a Summary List of eligible scholars to the Division of Child Care for approval or denial. Once approved and enrolled in a CCCC/CDA session; funds will be disbursed to the Approved Training organization on behalf of the scholar after completion of 30, 60, 90, and 120 hours of training.

Service Commitment: A scholarship applicant must commit that he or she will subsequently render service:

  • For six months at the participating early childhood facility upon obtaining the Commonwealth Child Care Credential.
  • For an additional six months at the participating early childhood facility upon obtaining the Child Development Associate Credential.

Instructions

  1. Read Program Information above.
  2. Complete and sign Section A of this application.
  3. Ask your employer to complete Section B this application.
  4. Submit this application to your area Professional Development Counselor to have Section C completed.
  5. Completed and signed applications may be submitted 45 days prior to the training start date and no later than 2 weeks prior to training start date. If application is not received within specified time frames, you may not receive scholarship Application.

1

SECTION A – APPLICANT CERTIFICATION

Below to be completed by Applicant: Please read page 2 and answer the following:

  1. Name: Mr. /Mrs. /Ms. ______
  1. Social Security Number ______- _____ - ______
  1. Permanent Address ______

STREET CITY STATE ZIP CODE

  1. Phone (____)______5. Birth Date ______/_____/______
  1. County of Residence ______7. Email Address: ______
  1. Are you a citizen, national, or permanent resident of the United States? Yes No
  1. Which of the following are you pursuing?

Commonwealth Child Care Credential Child Development Associate Credential

10Are you currently employed at least 20 hours weekly in a child care setting? Yes No

  1. Are you currently employed at least 20 hours weekly providing direct instruction to children as a teacher assistant in astate funded preschool program? Yes No
  1. Date of Employment at current participating facility: ______

MonthYear

  1. Are you eligible for other funding for scholarships through your employer? Yes No

If you answered "yes" to # 13, contact the Professional Development Counselor in your area before completing the remainder of the application.
  1. Circle which approved training organization do you plan to attend:

Thursday evening class: 6:00-9:00 p.m. Every other Saturday class: 9:00 a.m.-3:30 p.m.

Training start date: 8/3/2018Training start date: 8/25/2018

Boone County Public LibraryChildren, Inc. Training Office

1786 Burlington Pike333 Madison Ave.

Burlington, KY 41005Covington, KY 41011

Complete Certification Box.

Certification: I affirm that the information reported above is accurate and true to the best of my knowledge. I intend to obtain the credential specified above and render early childhood development services in Kentucky. In accordance with 11 KAR 16:010, I agree to provide the required service commitment after completion of any credential program.

______

Applicant Signature Date

2

SECTION B – EMPLOYER CERTIFICATION

To be completed by employer:

Certification:

  • I affirm that the information reported in this application is accurate and true to the best of my knowledge.
  • I further certify that the applicant is employed at the facilitynamed below
  • I certify that the applicant meets all employment requirements as outlined in outlined in 922 KAR 2:110 or 922 KAR 2:100 as of the date indicated in Section A
  • I agree to pay each recipient a book allowance for the purchase of the CDA Essentials Book in the amount of no more than $50.00, (**Term 1). I also agree to purchase an application packet for the CDA up to $50.00 (**Term 2) for each recipient who has completed all necessary training required to apply for a CDA.
  • I further agree to pay 10% of the CCCC and/or CDA Milestone Achievement Award to the student within fifteen (15) days following receipt of proof of completion of the CCCC and or the CDA Credential. (*See amount of payments listed below).

Name of Authorized Official:

______

(Printed) Title

Program Name: ______License or Certification Number: ______

Address: ______

Street City State Zip Code

Phone # (Including Area Code) ______

______

Signature Date

The applicant must submit this application with Sections A and B completed by the deadline specified on page 2
to the Professional Development Counselor.

* 10% of the Milestone Achievement Award for the Commonwealth Child Care Credential (CCCC) will be $10.00. Scholars

mustmeet the CCCC requirements stated in 922 KAR 2:250 to be eligible for a CCCC Milestone Award Payment.

* 10% of the Child Development Associate Credential (CDA) Milestone Achievement Award will be $25.00.

** Term 1 is the first 60 hours of instruction and Term 2 is the second 60 hours of instruction.

3

SECTION C -- TO BE COMPLETED BY PROFESSIONAL DEVELOPMENT COUNSELOR

I affirm that the information reported in Sections A and B is complete, accurate, and true to the best of my knowledge. Based on this information, I further certify that the facility is operating in good standing and that the applicant meets the eligibility criteria for the Commonwealth Child Care Credential/Child Development Associate Credential Scholarship Program and recommend that the applicant receive a scholarship in the total amount of:

$210.00 for 60 hrs. of instruction toward Commonwealth Child Care Credential (Term I)

$210.00 for 60 hrs. of instruction toward the Child Development Associate Credential (Term II)

Scholarship Application Summary List Approval Date: ______

Total amount recommended for disbursement: $____210.00______

______Hallie Smith______859-442-4161______

Professional Development Coach Phone Number

_525 Scott St. Covington ______KY______41011______

Street City State Zip Code

______

SignatureDate

Counselor: Keep Original application in the individual’s file and return a completed copy to the applicant.