WINDWARD P-3 REQUEST FOR LOAN FOR HEAD START STAFF
Name: / School: / Phone:Position: / Email Address: / FAX:
Request for Loan:
**REQUIRED Attachments: Name of college or university:
Certificate/Degree Plan at an accredited college or university
Registration Confirmation Degree title and major:
Other Scholarships Awarded
Course ID / # of Credits / Cost/Credit / Semester/yr. / Enrollment dates / FOR OFFICE USE
Retention Policy and Agreement:
Early childhood staff that receives financial assistance from the Windward P-3 Grant to enroll in college courses required for a College Degree or a Child Development Associate Credential (CDA) must agree to reimburse the Windward P-3 Grant the amount of the loan when reimbursement is received from HCAP Head Start or if failing to earn a passing grade. Staff must also agree to work for at least 3 years in the windward area (from Waimanalo to SunsetBeach) after the completion of their degree or credentials (CDA or Early Childhood Certificate). If the employee should leave the area before three years they will be held responsible to repay all or a prorated amount of the financial assistance provided by the Windward P-3 Grant. The prorated amount will be determined by the fiscal department based on the total amount of tuition and/or other (books) assistance given to each staff. The total amount will be divided by the length of time the employee remains in the program (for up to three years) after receiving their degree, CDA or Certificate. The retention policy will expire after three years of service from the date of receiving their degree or credentials (CDA or Early Childhood Certificate). In the event that the employee resigns before the completion of their degree the employee will be responsible to pay back in full any financial assistance received as of December 1, 2010.
______(Signature) I have read, understand and agree to honor the requirements and commitments of the Windward P-3 Grant Retention Policy and Agreement stated above and will allow the Windward P-3 Grant to share information with HCAP Head Start.
Financial Responsibilities (Check one that applies and initial)
______(Initial) I plan to submit a request for reimbursement at the end of the semester
______I agree to reimburse the Windward P-3 Grant the amount of the loan that was paid to an accredited college/university when I receive reimbursement from HCAP Head Start or if I fail to earn a passing grade (Checks payable to: Kamalapua O Ko’olau)
Request for: Workshops/Conferences/Institutes
**REQUIRED Attachments:
Flyer/brochure/agenda
Registration form (completed)
½ page essay: How the training will benefit your professional development
Name of training:
Date of training:
Early Bird registration deadline:
Registration deadline:
Cost of training:
Eligibility Requirements for approval (excludes out of town travel): All items are due at least 6 weeks prior to the date of the training. This ensures adequate time to process payment for approved trainings. You will receive notification of your approval/disapproval at least two weeks prior to the training via email. You may be asked to share or present information/knowledge gained at the training for up to two years after attending the training.
Approved / Not Approved / Signatures / Date / Amount Approved
P-3 Coordinator:
KOK Board Member:
KOK Treasurer:
Rev. 12/03/10