### *OMB No: 1840-0763*

#### Expiration Date: ##/##/####

**Child Care Access Means Parents in School (CCAMPIS) Program**

**Annual Performance Report**

# [Section I -- Project Identification, Certification and Warning]{.underline}

A. Identification

1\. PR Award Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. Name and Address of Grantee Institution
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. Name and Address of Project Director
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. Project Director's Contact Information

Telephone Numbers:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Fax Numbers:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

E-mail Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5\. Grantee Institution Status (check one)

\_\_\_\_\_ 2-year public institution \_\_\_\_\_ 4-year public
institution

\_\_\_\_\_ 2-year private institution \_\_\_\_\_ 4-year private
institution

B. Certification: We certify that the performance report information
reported and submitted on \_\_\_\_\_\_\_\_\_\_\_\_\_\_ is readily
verifiable. The information reported is accurate and complete to the
best of our knowledge.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Printed Name of Project Director Printed Name of Certifying Official

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Signature
Signature

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date Date

C. Warning: Any person who knowingly makes a false statement or
misrepresentation on this report is subject to penalties which may
include fines, imprisonment, or both under the United States Criminal
Code and 20 U.S.C. 1097. Further Federal funds or other benefits may be
withheld under this program unless this report is completed and filed as
required by existing law (20 USC 1231a) and regulations (34 CFR 75.590
and 75.720).

Authority: Public Law 102-325, as amended.

> According to the Paperwork Reduction Act of 1995, no persons are
> required to respond to a collection of information unless it displays
> a valid OMB control number. The valid OMB control number for this
> information collection is 1840-0763. The time required to complete
> this information collection is estimated to average 6 hours per
> response, including the time to review instructions, search existing
> data sources, gather the data needed, and complete and review the
> information collection. If you have any comments concerning the
> accuracy of the time estimate(s) or suggestions for improving this
> form, please write to: U.S. Department of Education, Washington, DC
> 20202-4651. If you have comments or concerns regarding the status of
> your individual submission of the form, write directly to: CCAMPIS
> Program, U.S. Department of Education, 1990 K Street, N.W., Suite
> 7000, Washington, DC 20006-8510.

# [Section II -- Definitions]{.underline}

> **Participant** --- An eligible postsecondary **student** receiving
> CCAMPIS Program funded services. To be eligible to receive CCAMPIS
> Program funded services, a postsecondary student must be "eligible to
> receive a Federal Pell Grant for the fiscal year for which the
> determination is made." See Section 419N(b)(7) of the *HEOA of 2008*.
> A **participant** is the Pell-eligible parent(s) of those children to
> whom you provide child care services. If you use CCAMPIS funds to pay
> salaries of child care providers/instructors, a **participant** is the
> Pell-eligible parent(s) of those children in the class(es) of the
> child care providers/instructors paid with CCAMPIS funds (Do not count
> as a **participant** those parent(s) who are not Pell-eligible.)
>
> **Non-participant** --- An individual receiving childcare services at
> your institution, but who is not receiving CCAMPIS Program funded
> services. This may include other students, community members, faculty,
> staff, etc.
>
> **Participant ID** --- The participant ID is a number from 1 to 1000
> used to uniquely identify each participant. Use a successively
> increasing number for each participant. Use the same number for each
> participant each time he/she is reported (example: a student assigned
> as Participant ID #1 must be reported as Participant ID #1 on
> subsequent annual reports).
>
> **Race**/**Ethnicity** --- The seven categories for the participant's
> ethnicity are *American Indian or Alaska Native* (AI), *Asian* (AS),
> *Black or African American* (B), *Hispanic or Latino* (H), *Hawaiian
> or Other Pacific Islander* (PI), *White* (W), and *Two or More Races
> (TM)*.
>
> **Gender** --- The two categories for the participant's gender are
> *male* (M) and *female* (F).
>
> **Household status** --- The three categories for the participant's
> household status are *Married* (M), *Not Married and Dependent on
> Parent(s)* (D), or *Not Married and Independent* (I). An unmarried
> participant who lives with or is supported by a person(s) other than a
> parent(s) is considered not married and independent.
>
> **Pell Grant status** --- The two categories for the participant's
> Pell Grant status are *Receiving Pell Grant* (R) or *Eligible but not
> receiving Pell Grant* (E).
>
> **Years taken to transfer/completion** --- The number of years that a
> participant was in school at your IHE before graduating/completing or
> transferring from your two-year IHE to a four-year IHE. This is the
> number of years between the first enrollment date and date of
> transfer/graduation/completion. Only fill in this column if the
> participant graduated/completed at your institution while receiving
> CCAMPIS services or transferred from your two-year IHE to a four-year
> IHE while receiving CCAMPIS services.
>
> **Degree/Certificate** --- The three categories for the participant's
> degree/certificate are *Certificate/Diploma* (C), *Associate's* (AA),
> *Bachelor's* (BA), or *Teaching Credential* (TC). Only fill in this
> column if the participant completed/graduated from your institution
> while receiving CCAMPIS services.
>
> **Number of children served** --- The number of the participant's
> children who are receiving CCAMPIS Program funded services whether
> enrolled full- or part-time in any licensed child care delivery system
> on or off campus. [Count each child only once]{.underline}.

# [Section III -- Participant Demographics, Persistence and Graduation]{.underline}

INSTRUCTIONS:

-   If your IHE has two academic terms during an AY -- running fall
    through spring -- fill in the information for the first term in the
    "Fall" column, and fill in information for the second term in the
    "Spring" column. Leave both the "Winter" and "Summer" columns blank.

```{=html}
<!-- -->
```
-   If your institution of higher education (IHE) has three academic
    terms during an academic year (AY) -- running fall through summer --
    fill in information for the first term of the academic year in the
    "Fall" column, fill in information for the second term in the
    "Spring" column, and fill in information for the third term in the
    "Summer" column. Leave the "Winter" column blank.

```{=html}
<!-- -->
```
-   However, if you have four academic terms during an AY -- running
    fall through summer -- fill in the information in the "Fall,"
    "Winter," Spring" and "Summer" columns, accordingly.

-   Data on previous participants, from past report years, must be
    filled in and all of the information on new participants must all so
    be completely filled in.

-   Code each participant using an A, G, T, or W, for each academic term
    in which the participant received CCAMPIS Program services at any
    time during the term.

    -   "A" designates a participant who completed the term without
        completing his/her studies, graduating, transferring, or
        withdrawing during the term or at the end of the term.

    -   "G" designates a participant who earned a certificate/diploma,
        associate's, bachelor's, or teaching credential during or at the
        end of the term.

    -   "T" designates a participant who transferred from your two-year
        IHE to a four-year IHE during or at the end of the term.

    -   "W" designates a participant who withdrew/dropped out/stopped
        out from your institution during the term. This includes
        participants who transferred from one two-year institution to
        another two-year institution or from one four-year institution
        to another four-year institution.

    -   Leave the academic term blank if the participant did not receive
        CCAMPIS Program services at any time during the term.

-   Copy additional tables from page 19 if needed to record additional
    participants.

-   If you would like to provide additional information on the academic
    outcomes of prior participants, please use a separate sheet of paper
    and attach it to this Report.

# Section III (cont'd) -- Participant Demographics, Persistence and Graduation

<table>
<colgroup>
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 10%" />
<col style="width: 4%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3"><blockquote>
<p>Participant ID</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Race/Ethnicity</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Gender</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Household status</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Pell Grant status</p>
</blockquote></td>
<td colspan="16">Term(s) in which participant received CCAMPIS Program
services</td>
<td rowspan="3">Years taken to transfer/ completion</td>
<td rowspan="3"><blockquote>
<p>Degree/Certificate</p>
</blockquote></td>
<td rowspan="3">Number of children served</td>
</tr>
<tr class="even">
<td colspan="4">2005-2006</td>
<td colspan="4">2006-2007</td>
<td colspan="4">2007-2008</td>
<td colspan="4">2008-2009</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
</tr>
<tr class="even">
<td>1</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>2</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>3</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>4</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>5</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>6</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>7</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>8</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>9</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>10</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>11</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>12</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>13</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>14</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>15</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>16</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>17</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>18</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>19</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

# Section III (cont'd) -- Participant Demographics, Persistence and Graduation

<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 10%" />
<col style="width: 4%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3"><blockquote>
<p>Participant ID</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Race/Ethnicity</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Gender</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Household status</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Pell Grant status</p>
</blockquote></td>
<td colspan="16">Term(s) in which participant received CCAMPIS Program
services</td>
<td rowspan="3">Years taken to transfer/ completion</td>
<td rowspan="3"><blockquote>
<p>Degree/Certificate</p>
</blockquote></td>
<td rowspan="3">Number of children served</td>
</tr>
<tr class="even">
<td colspan="4">2005-2006</td>
<td colspan="4">2006-2007</td>
<td colspan="4">2007-2008</td>
<td colspan="4">2008-2009</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
</tr>
<tr class="even">
<td>20</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>21</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>22</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>23</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>24</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>25</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>26</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>27</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>28</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>29</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>30</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>31</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>32</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>33</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>34</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>35</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>36</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>37</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>38</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

# Section III (cont'd) -- Participant Demographics, Persistence and Graduation

<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 10%" />
<col style="width: 4%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3"><blockquote>
<p>Participant ID</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Race/Ethnicity</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Gender</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Household status</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Pell Grant status</p>
</blockquote></td>
<td colspan="16">Term(s) in which participant received CCAMPIS Program
services</td>
<td rowspan="3">Years taken to transfer/ completion</td>
<td rowspan="3"><blockquote>
<p>Degree/Certificate</p>
</blockquote></td>
<td rowspan="3">Number of children served</td>
</tr>
<tr class="even">
<td colspan="4">2005-2006</td>
<td colspan="4">2006-2007</td>
<td colspan="4">2007-2008</td>
<td colspan="4">2008-2009</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
</tr>
<tr class="even">
<td>39</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>40</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>41</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>42</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>43</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>44</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>45</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>46</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>47</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>48</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>49</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>50</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>51</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>52</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>53</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>54</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>55</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>56</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>57</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

# Section III (cont'd) -- Participant Demographics, Persistence and Graduation

<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 10%" />
<col style="width: 4%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3"><blockquote>
<p>Participant ID</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Race/Ethnicity</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Gender</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Household status</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Pell Grant status</p>
</blockquote></td>
<td colspan="16">Term(s) in which participant received CCAMPIS Program
services</td>
<td rowspan="3">Years taken to transfer/ completion</td>
<td rowspan="3"><blockquote>
<p>Degree/Certificate</p>
</blockquote></td>
<td rowspan="3">Number of children served</td>
</tr>
<tr class="even">
<td colspan="4">2005-2006</td>
<td colspan="4">2006-2007</td>
<td colspan="4">2007-2008</td>
<td colspan="4">2008-2009</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
</tr>
<tr class="even">
<td>58</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>59</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>60</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>61</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>62</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>63</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>64</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>65</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>66</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>67</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>68</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>69</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>70</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>71</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>72</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>73</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>74</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>75</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>76</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

# Section III (cont'd) -- Participant Demographics, Persistence and Graduation

<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 10%" />
<col style="width: 4%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3"><blockquote>
<p>Participant ID</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Race/Ethnicity</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Gender</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Household status</p>
</blockquote></td>
<td rowspan="3"><blockquote>
<p>Pell Grant status</p>
</blockquote></td>
<td colspan="16">Term(s) in which participant received CCAMPIS Program
services</td>
<td rowspan="3">Years taken to transfer/ completion</td>
<td rowspan="3"><blockquote>
<p>Degree/Certificate</p>
</blockquote></td>
<td rowspan="3">Number of children served</td>
</tr>
<tr class="even">
<td colspan="4">2005-2006</td>
<td colspan="4">2006-2007</td>
<td colspan="4">2007-2008</td>
<td colspan="4">2008-2009</td>
</tr>
<tr class="odd">
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
<td><blockquote>
<p>Fall</p>
</blockquote></td>
<td><blockquote>
<p>Winter</p>
</blockquote></td>
<td><blockquote>
<p>Spring</p>
</blockquote></td>
<td><blockquote>
<p>Summer</p>
</blockquote></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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# Section IV -- Number of Non-participants 

Indicate the number of non-participants and number of their children
served from the CCAMPIS Project award date until the end of the current
reporting period.

A.  Total number of non-participants served:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

B.  Total number of non-participants' children served:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# Section V -- Project Services and Activities 

A. CCAMPIS Program Funded Services Provided for Participants

> [Check all that apply.]{.underline} Do not indicate number of
> participants using these services; simply check whether or not you
> provide these services either directly (Institution-run) or by
> contract with a third-party (Contracted).
>
> Type of Service Institution-run Contracted
>
> 1\. Full-time childcare services ­\_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 2\. Part-time childcare services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 3\. Before-care services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 4\. After-care services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 5\. Evening services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 6\. Weekend Services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 7\. Summer Term Services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 8\. 24-hour Services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 9\. Emergency Services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 10\. Drop-in Services (hourly) \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 11\. Parenting Classes \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 12\. Seminars \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 13\. Meetings \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 14\. Other -- specify
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_
> \_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_
> \_\_\_\_\_\_

B. Fee Schedule for Participants and Non-participants:

[Check all that apply.]{.underline}

Participants Non-participants

> 1\. Sliding Fee Scale \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 2\. Free Child Care Services \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 3\. Standard-set Fee \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 4\. Partial Tuition/Scholarship for child \_\_\_\_\_\_\_ \_\_\_\_\_\_

# Section V (cont'd) -- Project Services and Activities 

C. Availability of Institution-run and Contracted Child Care Services:

[Check all that apply.]{.underline} Waiting list for childcare services
for CCAMPIS-eligible

Students.

Institution-run Contracted

> 1\. The semester prior to the CCAMPIS Program
>
> grant award funding \_\_\_\_\_\_\_ \_\_\_\_\_\_
>
> 2\. At the beginning of the 2006-07 academic year \_\_\_\_\_\_\_
> \_\_\_\_\_\_
>
> 3\. At the beginning of the 2007-08 academic year \_\_\_\_\_\_\_
> \_\_\_\_\_\_
>
> 4\. At the beginning of the 2008-09 academic year \_\_\_\_\_\_\_
> \_\_\_\_\_\_
>
> 5\. At the beginning of the 2009-10 academic year \_\_\_\_\_\_\_
> \_\_\_\_\_\_

D. Explain how the CCAMPIS Program funded childcare services have
coordinated with the Institution's Early Childhood Education (ECE)
program. (The ECE program refers to the Institution's academic program
for college students seeking credit for course work involving ECE.)
*Please use a separate sheet of paper and attach it to this Report.*

# Section VI -- Campus and Community Resources and Funding

# 

# Identify the resources, including technical expertise and financial support, the institution has used to support the child care program and participation in the CCAMPIS program. Specify type of funds, funding entity, and amounts:

A. Local/Community Funding: Total \$\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

B. State Funding: Total \$\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

C. Institutional Student Activity Fees: Total \$\_\_\_\_\_\_\_

D. Other fees: Total \$\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# Section VI (cont'd) -- Campus and Community Resources and Funding

# 

E. Foundation grants: Total \$\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

F. Institutional funds: Total \$\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

G. In-kind contributions: Total \$\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

H. Explain how you have leveraged the Institution's and local resources
to support child care activities for low-income (Pell
Grant-eligible/CCAMPIS Program eligible) students, and how the use of a
sliding fee scale resulted in a high number of such students obtaining a
postsecondary education. *Please use a separate sheet of paper and
attach it to this Report.*

# Section VII -- Child Care Services Accreditation and Licensing

A. Campus-Based Child Care Program:

For institution-run, on-campus CCAMPIS Program funded childcare
services, provide the requested information on accreditation and
licensing.

1\. Is the CCAMPIS Program funded childcare program accredited? \_\_\_
Yes \_\_\_ No

2\. If the program is accredited:

> a\. Date of accreditation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\. Expiration of accreditation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> c\. Accrediting Agency -- Name and Address

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. If the program is not accredited:

> a\. Are you in the process of obtaining accreditation? \_\_\_ Yes
> \_\_\_ No
>
> b\. Check all the steps completed in accreditation process:
>
> \_\_\_ Self-Assessment \_\_\_ Applying for Candidacy
>
> \_\_\_ Candidacy Status \_\_\_ Awaiting an Accreditation Visit
>
> \_\_\_ Awaiting Renewal Visit \_\_\_ Awaiting Commission Decision
> \_\_\_ Deferred
>
> c\. Estimated date accreditation is expected:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\. Accrediting Agency -- Name and Address

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. If this is a [new]{.underline} child care program (less than 3 years
established), detail the actions taken, including a timeline to achieve
the goals set forth in the application. *Please use a separate sheet of
paper, and attach it to this Report.*

5\. Is the childcare program and facility licensed by the State and
local licensing agencies? \_\_\_ Yes \_\_\_ No

# Section VII (cont'd) -- Child Care Services Accreditation and Licensing

B. Off-Campus Contracted Child Care Program:

If you contract out the childcare services, provide the requested
information on accreditation and licensing for each childcare facility
with which you contract using CCAMPIS Program funds. *Please use a
separate sheet of paper for each additional contracted childcare
facility and attach it to this Report.*

1\. Is the CCAMPIS Program funded childcare program accredited? \_\_\_
Yes \_\_\_ No

2\. If the program is accredited:

> a\. Date of accreditation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\. Expiration of accreditation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> c\. Accrediting Agency -- Name and Address

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. If the program is not accredited:

> a\. Are you in the process of obtaining accreditation? \_\_\_ Yes
> \_\_\_ No
>
> b\. Check all the steps completed in accreditation process:
>
> \_\_\_ Self-Assessment \_\_\_ Applying for Candidacy
>
> \_\_\_ Candidacy Status \_\_\_ Awaiting an Accreditation Visit
>
> \_\_\_ Awaiting Renewal Visit \_\_\_ Awaiting Commission Decision
> \_\_\_ Deferred
>
> c\. Estimated date accreditation is expected:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\. Accrediting Agency -- Name and Address

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. If this is a [new]{.underline} child care program (less than 3 years
established), detail the actions taken, including a timeline to achieve
the goals set forth in the application. *Please use a separate sheet of
paper, and attach it to this Report.*

5\. Is the childcare program and facility licensed by the State and
local licensing agencies? \_\_\_\_\_\_ Yes \_\_\_\_\_ No