TECTA Scholarship Information

You are responsible for:

./ Admitting to the college

./ Registering for the class or classes you plan to take

./ Paying your fees on time

./ Knowing your class location and start date

./ Knowing the requirements of the college, including the withdrawal procedures .

./ This information and a lot more can be found on the website of the college you plan to attend.At Dyersburg State Community College the website is www.dscc.edu

Scholarship Ayailability:

./ Scholarship availability depends on TECTA funding .

./ TECTA (Tennessee Ear ly Childhood Training Alliance) is a grant program funded by the Center ofExcellence for Learning Sciences at Tennessee State University through a contract with the Department ofHuman Services .

./ Our fiscal year begins July 01 st of each year. Financial assistance for the following 12 months is determinedat that time .

./ Scholarship applications WILL NOT be considered until ALL required information has been submitted.

Scholarship Eligibility:

./ All students must complete the 30 hour free orientation training before they can be assisted in any way by ourprogram .

./ Tuition scholarships through the TECTA program are available for individuals who are currently working inchildcare regulated through the Department of Human Servces or preschool programs through the Departmentof Educatio n.

Eligibility Requirements;

./ In order to qualify for continued TECTA support, the student must provide an unofficial transcript showing thathe/she completed and passed the course(s) for which he/she received financial support from the TECTAprogram .

./ An unofficial transcript can be accessed through web registration at your college and attached to thescholarship form .

./ If the student did not pass a course funded by the TECTA program, the student is ineligible for a scholarshipunti Ithe course is passed and paid for by the student.

CDA Related Courses;

./ The early childhood courses offered at the college level are college credit classes not "TECTA" or "CDA"classes. "CDA-related" courses are those early childhood courses pre-approved by the CDA Council that meetthe education requirement for CDA application .

./ The Council for Professional Recognition, located in Washington, D.C. awards the CDA credential.

./ The CDA-related courses are ECED 2310(previously ECED 2010), ECED 2335(previously ECED 2BO),ECED 2315(previously ECED 20 15), and ECED 2340 (previously ECED 2040) .

./ The TECTA staff serve as CDA Mentors and PO Specialists.

More information on the back of this sheet

ADMISSION:

./ If yuare afirst time student, you must fill out an admission form. You can find out about the admissionprocess by going to the school'swebsite or visiting the admission office .

./ If you laebeen admitted before, but did not attend the previous semester, you MUST be readm itted tothe institution by completing the same registration form .

./ Students are responsible for completing all admission requirements required by the institution from which theclass is being taken

REGISTRATION:

./ You must register through the proper registration process for the school you plan to attend .

./ The TECTA Scholarship Form IS NOT THE REGISTRA nON FORM .

./ If you are afirst time student, you will be notified of the proper registration process AFTER you havecompleted the admission process .

./ If you are a returning student from the previous semester, the institution will contact you as to when youwill be allowed to register .

./ If you are a degree-seeking student, you must see your advisor to register for classes

AFTER You Register for Your Class(es), Print Off & Send With Your Scholarship Form:

L A CLASS SCHEDULE- showing the class(es) you will be taking this semester2. AN ACCOUNT SUMMARY - showing what you have been charged for the class(es)3. AN UNOFFICIAL TRANSCRIPT -MUST show your graders) from the last semester you attended

FINANCIAL INFORMATION:

./ You are responsible to pay the balance owed after the TECTA scholarship has been applied toyour account .

./ After your application has been approved, you will receive a confirmation email from the TECTA officeshowing the amount of your scholarship award .

./ Your scholarship award will be sent directly to the business office at the school you are attending. You mustpay your balance to prevent being dropped from the class .

./ Again, your account summary will show your balance. You can subtract the scholarship award fromthe balance on the account summary and send the balance owed to the business office at the institutionyou are attending.

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! -*1~ ., ,:~i~'\i:LCollege/University Semester _

Tennessee Early Childhood Training Alliance (TECTA)Application for Academic Financial Support

Tennessee Early Childhood Training AllianceDyersburg State Community College2071 Hwy 45 BypassTrenton, TN 38382

Phone: (731) 855-9198

year _ Textbook Only 0Course Name Subject Course Number Section _

Name: Last First Middle _

Social Security Number

Citizenship: 0United States

Gender: oMale oFemale

oOther E-mail _

DOB --.1__ --'1__ Ethnicity: 0 Hispanic oNon -Hispanic

Race: o Asian Paclfic Island

o Other Two or more races

o Native American Indian/Alaska Nativeo Black

o White

Address City State Zip _

Home County Home Phone (__ ) Cell Phone (__ ) _

Emergency Contact Person Phone (

Academic degree program this semester: Choose One

o CDA Prep 0 CDA Renewal 0 Technical Certificateo Associate Degree 0 Bachelor Degree 0 Graduate DegreeoAdministrator Credential

Desired Major o Early Childhood Education 0 Elementary Education PreK 0Other --------

Graduation Information I will graduate this semester o yes Ono

Place of Employment Work County

Work Address City State Zip

Name of Director: Last First

Phone (__ ) Fax (__ ) E-mail

Eligibility

In order to qualify for continued TECTA support, the student must provide a transcript showing that he/she completed and passed the previous course(s) forwhich he/she received financial support from the TECTA program.

NOTICE: If you have changed your name and/or address since you last enrolled in a TECTA-sponsored course, please fill out a Change of Name/Address formand return it as soon as possible to the local TECTA site,

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 willresult in your 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, and agree to pay the entire tuition fee for re-enrollment in a TECTA class, In addition, I grant TECTA permission to access my academic record.

Signature . _ Date _

TECT A at Dyersburg State Community College is funded by the Center of Excellence for Learning Sciences at Tennessee State Universitythrough a contract with the Department of Human Services. Revised 10-01-2014

Tennessee Early Childhood Training Alliance (TECTA)Student Information Form

lcnncssee Early Childhood Training AllianceDyersburg State Community College

2071 Hwy ~5 BypassTrenton. TN 38382

Phone : 1731) H55-919X

PLEASE PRINT CLEARL Y. Semester year _

TECT A Orientation Location or Institution Attending _

Social Security Number:

Name: Last First Middle _

Employment History

Ages of children in classroom (choose one)

oBirth to 8 months 0 9 to 17 months 0 18 to 36 months

OMixed Age Group Infants 0 Mixed age group Infant & Preschool

DAges 3 - 5 0 School Age

OFamily Childcare

Please note this question is for research purposes ONL Y. Individual responses will not be identified and published.

Salary:S per 0Hour Oday 0 week 0bi-weekly Omonrh 0 year

Current Position Title: OAsst. Director DAsst. Director/Teacher OCaregiver/Teacher 0Director

oDirector/Teacher OOther Downer of Program 0Sub/Floater

DAsst. Teacher 0 Volunteer

Number of years in current position Number years in Early Childhood Field _

Number of years at current place of employment: Hrs worked per week: _

Do you have children with diagnosed delays or disabilities in your classroom?

Number of Children in classroom _

Dyes 0 No

Please check the professional organization(s) to which you belong:

DHead Start Association DNational Association tor the Education of Young Children

ONational Black Child Development Institute ONational Child Care Association

ONational Family Child Care Association DTennessee Association for the Education of Young Children

OTennessee Family Child Care Alliance OTennessee School-Age Care Alliance

TECTA at Dyersburg State Community College is funded by the Center of Excellence for Learning Sciences at Tennessee State Universitythrough a contract with the Department of Human Services. Revised 10-01-2014

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Complete this portion only the first time you receive TECTA services

Highest educational achievements before seeking TEeTA support

o < 9th grade 0 9th - I th grade (no diploma) 0High School Graduate/GED

o some college 0 Technical certificate 0Associate Applied Science

o Associate 0 Baccalaureate 0Masters/Doctorate

College or university of highest degree _

Major: 0Early Childhood Education DElementary Education 0Special Education 0 Other _

Graduation Date /----

Parents Educational Levels:

Mother 0< 9th grade

o some college

oBaccalaureate

o 9th- 12th grade (no diploma) DHigh School Graduate/GED

o certificate OAssociate

o Masters/Doctorate

0< 9th grade

o some college

oBaccalaureate

o 9th- I th grade (no diploma)

o certi ficate

o Masters/Doctorate

DHigh School Graduate/GED

DAssociate

Father

Professional Objectives

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

o Further my education 0Help with my job search 0Improve my job skills 0Obtain CDA 0Obtain raise

[ have completed other early childhood training during the last 12 months 0 Yes 0 No

Was the training required by your employer? 0 Yes 0 No

Do you plan to continue working in child care? 0 Yes 0 No

If no, please tell why _

NOTICE: If you have changed your name and/or address since you last enrolled in a TECTA-sponsored course, please till out aChange of Name/Address form and return it as soon as possible to the local TECTA site.

TEeT A at Dyersburg State Community College is funded by the Center of Excellence for Learning Sciences at Tennessee State Universitythrough a contract with the Department of Human Services. Revised 10-01-2014

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Tennessee Early Childhood Training Alliance (TECTA)Dyersburg State Comm. College TECTA2071 Hwy 45 By-PassTrenton, TN 38382Phone: 731-855-9198Fax: 731-855-4865

Financial Support

Have you completed a TECTA orientation?

Q Yes, Date complete _-,--, ,......,.. _Q Need to make-up a module or modulesQ No

Textbooks: this section to be completed in the TEeT A office when you pick up your bookts)The TECTA program is loaning the following textbook(s) to me for the SPRING 2012 semester. I understand it is myresponsibility to return the textbook(s) to the TECTA office upon completion of the final exam. I realize that a damagedor unusable textbook or a textbook NOT RETURNED in a timely manner may affect my eligibility for futurescholarships.Textbook Name: Textbook Number: ----------------Textbook Name: Textbook Number:------------------------------------ ----------------

PLEASE INITIAL:

___ , understand that if this form is not sent in with an attached ACCOUNT SUMMARY, CLASSSCHEDULE, and a copy of my UNOFFICIAL TRANSCRIPT, the application is consideredincomplete and WILL NOT be processed. In order to qualify for continued TECTA support, the studentmust provide an unofficial transcript showing that he/she completed and passed the previous course(s) forwhich he/she received financial support from the TECTA program. An unofficial transcript can beaccessed through web registration at DSCC and JSCC and must be attached to this scholarship form.

___ 'understand that I am enrolling in an academic course and will be responsible for completing the class. If forany reason I cannot finish the course, I will submit notice to the TECTA office in writing immediately,return textbook, and agree to pay any remaining balance on my account.

___ I understand my student educational records are protected by the Family Education Rights and PrivacyAct of 1974, as amended (FERPA). Because' receive financial support from the TECTA program, , grantTECT A permission to access my academic status information. The information will be used to determineand verify my eligibility for continued financial support.

NOTICE: At any time during the semester, if you have a change in your name, address, telephone number,or work site, please contact the TECTA office as soon as possible.

I have read the attached instructions and I understand that I am enrolling in an academic course.

Signature: _ Date:

TECT A at Dyersburg State Community College is funded by the Center of Excellence for Learning Sciences at Tennessee State Universitythrough a contract with the Department of Human Services. Revised 10-01-2014

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Student Request to Share Information

Office of Admission and Records

Name of institution where student is enrolled

(Please Print)Student's Name ------------------------------------------------------------Last First Middle Initial

SS# _

Address:Street

City State Zip Code

Phone: ~)---------------Semester: _ Year: ----[ know that the Family Educational Rights and Privacy Act of 1974, as amended (FERP A) protects the privacyof my student educational records and limits access to the information contained in those records. Because Ireceive financial support covering all or part of my tuition from the TSU- TECTA program, I am herebyauthorizing the Office of Admissions and Records to release my grades and academic status information to thelocal TECTA Site Coordinator for transmission to the TSU- TECTA Management Office. The information willbe used to determine and verify my eligibility for continued TSU- TECTA financial support and will beprotected in accordance with the provisions of FERP A. My grade and academic status information should besent to:

Name:Address:

Ms. Kelly Tivey, West Tennessee TECTA Site CoordinatorOSCC Gibson County Center2071 Hwy 45 BypassTrenton, TN 38382

Phone: (731) 855-9198Fax: (731) 855-4865

Students Signature Date

TECT A at Dyersburg State Community College is funded by the Center of Excellence for Learning Sciences at Tennessee State Universitythrough a contract with the Department of Human Services. Revised 10-01-2014

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