TECTA Application for Academic Financial Support · 2020. 4. 22. · 4. Select “Academic Transcript” 5. Click “Submit” 6. Right click and choose “Print ... Microsoft Word

The TECTA program is funded through a contract with the Tennessee Department of Human Services and Tennessee State University,

Center of Excellence for Learning Sciences.

Revised 2/2017

Center of Excellence for Learning Sciences w Tennessee State University

TECTA Application for Academic Financial Support

Course Information College/University __________________________________ Semester ________ Year______________ Textbook Only_____ Course Name ______________________________________ Subject ________Course Number ________ Section _________ Personal Information Name: Last ___________________________________ First __________________________ Middle ___________________ Social Security Number _____-_____-______ Gender: � Male � Female Citizenship: � United States � Other E-mail ________________________________________________________ Date of Birth _____/_____/_______ Ethnicity: � Hispanic � Non -Hispanic Race: � Asian Pacific Islander � Black � Native American Indian/Alaska Native � Other � Two or more races � White Home Address ______________________________________________________________________________________ City ______________________________________________________ State ________ Zip ___________ Home County ________________________________ Home Phone (___)____________ Mobile Phone (___)____________ Emergency Contact Person _________________________________Phone (___)____________

Academic degree program this semester: � CDA Prep � CDA Renewal � Technical Certificate

� Administrator Credential � Associate Degree � Bachelors Degree � Graduate Degree

Desired Major: � Early Childhood Education � Elementary Education � Pre-K � Other________________

Graduation Status: I will graduate this semester: � Yes � No

Employment Information Your Place of Employment ______________________________________ County where you Work ____________________ Work Address _________________________________________________________________________________________ City _______________________________________________ State _______ Zip ___________ Name of Director: Last ________________________________ First _____________________________ Phone (___)____________Fax (___)____________ Director’s E-mail _____________________________________________

Agency Type � Center � Dept. of Education � Home Visitor � Family � Group Home � High School � Higher Education � Registered � Unregulated Eligibility I understand that I am enrolling in an academic course and will be responsible for completing the class. Failure to complete all information on this form will result in my application not being processed. If for any reason I cannot finish the course, I will submit notice to the TECTA office in writing immediately, return textbook(s), and agree to pay the entire tuition fee for re-enrollment in a TECTA class.

In order to qualify for continued TECTA support, each student must provide a transcript showing that they completed and passed the previous course(s) for which they received financial support from the TECTA program. By signing below I give permission to the institution to release my academic progress and records to representatives from the Tennessee Early Childhood Training Alliance.

Signature __________________________________________________________ Date ______________________

Phone : (931) 221-7585Austin Peay State UniversityPO Box 4514Clarksville, TN 37044



Revised 4/2017


TECTA Student Information Form

TECTA Orientation Location or Institution Attending ________________________________________________________

Social Security Number _____ - _____ - _______

Name ________________________________ ________________________ _____________________ Last First Middle Employment Status Your Place of Employment _______________________________________________________________________________

Ages of children in classroom (choose one)

o Birth to 8 months o 9 to 17 months o 18 to 36 months o 3 to 5 year olds

o School-Age o Family Childcare

o Mixed-age Group: Infants o Mixed-age Group: Infants and Preschool o Not a Direct Care Provider

TECTA Support Received for: Semester ___________ Year ____________

Salary: Please note: this question is for research purposes ONLY. Individual responses will not be identified or published.

$ ____________ per Hour

Current Position Title: o Asst. Director o Asst. Director/Teacher o Caregiver/Teacher

o DHS Staff o Director o Director/Teacher o Home Visitor

o Home Visitor Supervisor o Other o Owner of Program o Sub/Floater

o Teacher Aide o Authorized o Volunteer

Number of years in current position ________ Number of years in Early Childhood Field _______

Number of years at current place of employment _______ Hours worked per week_____________

Do you have children with diagnosed delays or disabilities in your classroom? o Yes o No

Number of children in your classroom____________

Please complete the reverse side if you are a first-time TECTA-supported student.



Revised 4/2017


TECTA Student Information Form

Complete this side if this is the first time you are receiving TECTA services. Please check the professional organization(s) to which you belong:

o Head Start Association o National Association for the Education of Young Children

o National Black Child Development Institute o National Child Care Association

o National Family Child Care Association o Tennessee Association for the Education of Young Children

o Tennessee Family Child Care Alliance o Tennessee School-Age Care Alliance

Highest education level completed before seeking TECTA support

o Less than 9th grade o 9th – 12th grade (no diploma) o High School Graduate/GED

o Some College o Technical Certificate o Associate of Applied Science

o Associate Degree o Bachelors/Baccalaureate Degree o Masters/Doctorate Degree

College or University of Highest Degree ________________________________________________________

Major: o Early Childhood Education o Elementary Education o Special Education

o Other ____________________ Graduation Date of Highest Degree ______/_________

Parents’ Educational Levels

Mother




Father




Professional Objectives

Why do you want to participate in TECTA training? (Check all that apply):

o Further my education o Help with my job search o Improve my job skills o Obtain a CDA

o Obtain a raise/higher pay

Have you completed other early childhood training during the last 12 months? o Yes o No

Did your employer require the training? o Yes o No

Do you plan to continue working in child care? o Yes o No

If no, please tell us why_________________________________________________________________________________

NOTICE: If you have changed your name and/or address since you last enrolled in a TECTA-supported course, please fill out a TECTA Student Change of Information Form and return it as soon as possible to your local TECTA site.

Records Office Nashville State Community College 120 White Bridge Road

Student Services Building Suite 207

Nashville, TN 37209

615-353-3218

Fax: 615-353-3302

Request to Share Information forms must be accompanied by a valid photo ID if mailing or faxing the

form. Students submitting the form in person must be prepared to show a valid photo ID.

Our office will require that the student be the one to submit the form.

Student’s Name _________________________________________ Student ID: _____________________________________________ I know that the Family Educational Rights and Privacy Act of 1974, as amended (FERPA), protects the privacy of my student educational records and limits access to the information contained in those records. I have indicated below the individual(s) who may have information from my educational records.

1. Name/s_____________________________________________________ Relationship to Student _____________________________________ Address_____________________________________________________ _____________________________________________________________ Phone ______________________________________________________

If they ask, I approve the above named individual(s) to be informed about (initial all that apply).

______________ my grades ______________ my academic standing ______________ my major ______________ my graduation status ______________ my enrollment

Student Signature___________________________________________ Date___________________________

Processed by________________________________________________ Date___________________________ Student ID viewed by _______________________________________ Date___________________________

NSCC 08-17. NSCC is a TBR institution, AA/EEO employer, and does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, religion, creed, national origin, sex, sexual orientation, gender identity/expression, disability, age,

status as a protected veteran, genetic information, or any other legally protected class with respect to all employment, programs and

activities sponsored by NSCC. Inquiries regarding non-discrimination policies: Director of Human Resources, [email protected],

120 White Bridge Road, 615-353-3305, The Nashville State policy on nondiscrimination can be found at www.nscc.edu/legal/non-

discrimination-policy, Printer: NSCC Copy Center 120 White Bridge Road Nashville TN 37209 Quantity: 19500, © 2016, NSCC.

Noelle Cannon, Director - Tecta at APSUFunding Source

Austin Peay State University - TECTA OfficePO Box 4514 - Clarksville, TN 37044

931-221-7585

ORIENTATION CERTIFICATE OR TRANSCRIPTS

NEW STUDENTS

1. Make a copy of your TECTA Orientation Certificate

2. Add this copy to your Tuition Assistance Packet

3. Store your original certificate in a safe place where you can always find it

RETURNING STUDENTS

1. Log in to your student account (myNSCC) using your A# and PIN

2. Choose the “Student” Tab

3. Select “Student Records”

4. Select “Academic Transcript”

5. Click “Submit”

6. Right click and choose “Print”

7. Add printed Transcripts to your Tuition Assistance Packet

ACCOUNT DETAIL

(STATEMENT OF FEES)

ALL STUDENTS



3. Choose “Student Account”

4. Choose “Account Detail for Term/Confirm Enrollment/Credit Card Payment

5. Select the Current Term

6. **OPTIONAL: If you wish to pay the student portion of your tuition now you

may do so. If not, go to next step.

7. Right Click and Choose “Print”

8. Add printed Account Detail to your Tuition Assistance Packet

STUDENT DETAILED SCHEDULE

ALL STUDENTS



3. Choose “Student Detail Schedule”

4. Right Click and Choose “Print”

5. Add printed Account Detail to your Tuition Assistance Packet

PROOF OF EMPLOYMENT

In Licensed Child Care Program

In Tennessee

All Students

1. Obtain one of the following as proof of employment:

Most Recent Pay Stub

Letter from Employer – Written on Letterhead and Dated within the last 2

weeks

Copy of License (Owners only)

2. Make a copy

3. Add printed copy to your Tuition Assistance Packet

Student Tuition Portion

All Students

Students must show their portion of Tuition to TECTA staff prior to being issued a

voucher. The following are acceptable payment methods:

Personal Check made out to NSCC

Money Order made out to NSCC

If you chose to pay your portion online through myNSCC, your Account

Detail/Statement of fees will reflect this and you do not need further

documentation.

Student Portion: $50 per class

*Bachelor’s Level Courses: TECTA will pay 85% of your tuition as funding is

available.

CollegeUniversity: Semester: Year: Course Name: Subject: Course Number: Section: Name Last: First: Social Security Number: undefined: undefined_2: Check Box1: OffCheck Box2: OffMiddle: Check Box4: OffCheck Box3: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box5: OffCheck Box6: OffCheck Box11: OffCheck Box12: OffDate of Birth: undefined_4: undefined_3: Home Address: City: State: Zip: Home County: area code 1: undefined_5: area code 2: undefined_6: Email: Emergency Contact Person: area code 3: undefined_7: Check Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box1a: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffCheck Box23: OffOther: Check Box24: OffYour Place of Employment: County where you Work: Work Address: City_2: State_2: Zip_2: Name of Director Last: First_2: area code 4: undefined_8: area code 5: undefined_9: Email_2: Check Box26: OffCheck Box27: OffCheck Box28: OffCheck Box29: OffCheck Box30: OffCheck Box31: OffCheck Box32: OffCheck Box33: OffCheck Box25: OffCheck Box34: Offwatermark0: TECTA Orientation Location or Institution Attending: dummyFieldName1: dummyFieldName2: dummyFieldName3: Name: dummyFieldName4: dummyFieldName5: Place of Employment: Ages: OffdummyFieldName6: dummyFieldName7: dummyFieldName8: DHS Staff: OffHV Supervisor: OffTeacher Aide: OffAsst director: Offdirector: Offother: OffUnregulated Provider: OffAsst Teacher: Offdirector teacher: Offowner: Offvolunteer: OffCaregiver: OffHome Visitor: Offsub: OffNumber of years in current position: Number of years in Early Childhood Field: Number of years at current place of employment: Hours worked per week: yes disabilities: Offno disabilities: OffNumber of children in your classroom: HSA: OffNBCDI: OffNFCCA: OffTFCCA: OffNAEYC: OffNCCA: OffTAEYC: OffTSACA: Offless than 9: Offsome college: Offassoc degree: Off9-12: Offtech cert: Offbach degree: Offhs ged: Offaas: Offmaster doc: OffCollege or University of highest degree: ECE: OffElem Ed: OffSpec Ed: OffOther Ed: OffD Other: Graduation Date: dummyFieldName9: less than 9 2: Offsome college2: Offassoc degree2: Offless than 9 3: Offsome college3: Offassoc degree3: Off9-12 2: Offtech cert2: Offbach degree2: Off9-12 3: Offhs ged3: Offaas2: Offmaster doc2: Offhs ged2: Offtech cert3: Offaas3: Offbach degree3: Offmaster doc3: Offfurther ed: Offjob search: Offimprove skills: OffCDA: Offraise: Offno required: Offno continue: Offyes training: Offno training: Offyes required: Offyes continue: OffIf no please tell us why:

Documents

TECTA Application for Academic Financial Support · 2020. 4. 22. · 4. Select “Academic Transcript” 5. Click “Submit” 6. Right click and choose “Print ... Microsoft Word