UNITED STATES DEPARTMENT OF EDUCATION 

OFFICE OF POSTSECONDARY EDUCATION 

CHILD CARE ACCESS MEANS PARENTS IN SCHOOL (CCAMPIS) PROGRAM OMB NO: 1840-0763 

Exp. Date: 01/31/2026

ANNUAL PERFORMANCE REPORT FORM 

SECTION I: IDENTIFICATION - PROJECT IDENTIFICATION, CERTIFICATION AND WARNING 

A. Identification

1. PR Award Number:

2. Grantee Institution Information: Institution Name

OPEID: 

Address 

City State Zip Code 

Hours of Operation 

3. Project Director's Information: Project Director's Name

Address 

City State Zip Code 

Phone Number Fax Number 

Email Address 

4. Grantee Institution Status (check one) 2-year public 2-year private 4-year public 4-year private

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 my knowledge. 

Project Director's Name Certifying Official's Name 

Signature Signature 

Date Date 

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Child Care Access Means Parents in School (CCAMPIS) Program

 Annual Performance Report Form 

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), regulations (34 CFR 75.590 and 

75.720), and authority (P.L. 102-335, as amended). 

Paperwork Burden Notice: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of 

information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is 

estimated to average 28 hours per response, including time for reviewing instructions, searching existing data sources, gathering and 

maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is 

mandatory citing (Education Department General Administrative Regulations, § 80.40)/required to obtain or retain benefit citing (Education 

Department General Administrative Regulations, § 80.40)/ or voluntary. Send comments regarding the burden estimate or any other aspect 

of this collection of information, including suggestions for reducing this burden, to regulations.gov during the public comment period for this 

collection of information. If you have specific questions about the form, instrument or survey, please contact (to the U.S. Department of 

Education, 400 Maryland Avenue, S.W. 279-11,Washington, DC 20210-4537 or e-mail Harold.Wells@ed.gov). 

SECTION II: DEFINITIONS 

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 Pelleligible 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 do not meet CCAMPIS participation requirements.) 

As a result of the Higher Education Opportunity Act of 2008 (HEOA), students enrolled in a graduate or first professional course of 

study and students in the United States for a temporary purpose are eligible to receive the benefits of CCAMPIS-supported projects. 

(See HEOA, Sec. 410(7)(B)(i)and (ii)) 

Participant ID The participant ID is the college or university identification number (NOT THE SOCIAL security NUMBER) used at the institution to 

uniquely identify each participant. Use the same number for each participant each time he/she is reported (example: a student assigned 

as Participant ID #0678 must be reported as Participant ID #0678 on subsequent annual reports). 

Race/Ethnicity The seven categories set for participant 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 set for the participant gender are male (M) and female (F). 

Household Status The three categories set for the participants' household status are Married (M), Not Married and Dependent on Parent(s) (D), and 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 set for the participants' Pell Grant status are Receiving Pell Grant (R) and Eligible but not receiving Pell Grant (E). 

Additionally, students may be coded as Low Income Graduate Student (LIG), or Low Income Foreign Student (LIF). 

Academic Status The registration status of participating CCAMPIS student-parents. This may be Enrolled (E), Graduated (G), Transferred (T) or 

Withdrew (W). 

CCAMPIS Report whether or not the student-parent participated in the CCAMPIS program while enrolled at the institution or declined CCAMPIS 

Participation Status participation at any point while enrolled. Participation status selection codes is: Enrolled Participating in CCAMPIS (EPC), Enrolled but 

Declined CCAMPIS Participation (EDPC) or Withdrew From CCAMPIS Participation (WFCP). 

Non-Participant Individual receiving child care services, but who is not supported with CCAMPIS Program funds. This may include other students, 

community members, faculty, staff, etc. 

Years Taken to The number of years that a participant has taken to transfer (from a two-year institution to a four-year institution) or graduate (with a 

Transfer/ degree or certificate) from your institution of higher education (IHE) while receiving CCAMPIS funded services. 

Completion 

Degree/ The five categories for the participants' degree/certificate are: Certificate/Diploma (C), Associate's (AA), Bachelor's (BA), Teaching 

Certificate Credential (TC), and Master's (MS) Degrees. Only fill in this column if the participant completed/graduated from your institution while 

receiving CCAMPIS services. 

Number of Hours Record the number of hours of child care paid for with CCAMPIS funds for each parent participant.

of Child Care *Note: In the cases of dual-parents (married couples, shared parenting relationships), the child/ren should be counted for each studentparent independently. Child/ren and hours of child care are reported specific to each parent participant. Provided 

Halftime/Part An enrolled student who is carrying a half-time academic workload, as determined by the institution, that amounts to at least half of the 

time Status workload of the applicable minimum requirement outlined in the definition of a full-time student. 

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Child Care Access Means Parents in School (CCAMPIS) Program

 Annual Performance Report Form 

Section III-A: PARTICIPANT DEMOGRAPHICS, ATTENDANCE, PERSISITANCE AND GRADUATION 

INSTRUCTIONS: The 2022-2023 report must also reflect data reported by the institution for that period. 

 Definitions for selection choices for each column are found below.

 In the Fiscal Year field, select the appropriate fiscal year for which you are reporting from the drop down list,

 Reporters must manually input data for the Participant Codes (college or university identification number used at the institution to

uniquely identify each participant - NOT SOCIAL security NUMBERS), Years taken to transfer or completions, and Number of

Children served.

 If your IHE has two academic terms during an academic year (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.

 If your 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.

 However, if you have four academic terms during an academic year (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 also be

completely filled in. Provide data from past years by clicking the 'Add a School Year Button' at the bottom of the survey data chart.

 Code each participant using an E, G, T, or W for each academic term in which the participant received CCAMPIS Program services

at any time during the term.

o “E” 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.

o “G” designates a participant who earned a certificate/diploma, associate's, bachelor's, or teaching credential during or at the end

of the term.

o “T” designates a participant who transferred from your two-year IHE to a four-year IHE or from one four-year institution to

another four-year institution during or at the end of the term.

o “W” designates a participant who officially withdrew from your institution during the term.

 Code each participant using an EPC or EDPC for each academic term in which the participant received CCAMPIS Program services

at any time during the term.

o “EPC” designates a participant that is enrolled at the institution and an Enrolled Participating in CCAMPIS

o “EDPC” designates a participant that is enrolled at the institution; but has declined CCAMPIS program participation.

o “WFCP” designates a participant that withdrew from the institution and was withdrawn from CCAMPIS program participation.

 If applicable, report data for multiple school years by clicking the Add School Year button at the bottom of the survey data chart.

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Child Care Access Means Parents in School (CCAMPIS) Program

 Annual Performance Report Form 

Section III-B: PARTICIPANT DEMOGRAPHICS, ATTENDANCE, PERSISTANCE AND GRADUATION 

INSTRUCTIONS: Enter responses to the following eight questions. 

(Data reported below should be reconciled with data reported in the chart at the end of this form) 

1. Total Number of CCAMPIS student-parents reported on the institution's APR 

that persisted at the institution in

2. Total Actual Number of CCAMPIS student-parents attended/enrolled in Total Actual

3. Number of CCAMPIS student-parents that graduated from the institution in

4. Total Actual Number of CCAMPIS student-parents that withdrew from the institution in

APR 

expected to persist at the institution into

5. Total Actual Number of CCAMPIS student-parents reported on the institution's

6. Total Actual Number of CCAMPIS student-parents that graduated from the 4-year institution in the reporting year:

Certificate Diploma (BS/BA) Diploma (MS/MA)

7. Total Actual Number of CCAMPIS student-parents that transferred from a 2-year institution to a 4-year institution in this

reporting year:

Certificate With a Diploma (AA) Without a Diploma (AA) 

FY 2019-20 FY 2020-21 FY 2021-22 FY 2022-23 FY 2023-24

Certificate 

Seeking Students 

Degree Seeking 

Students 

Graduate Degree 

Seeking Students 

*Data is not required for FY 2023-24.

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8. What was the grade point average of CCAMPIS student-parents enrolled at the institution during the reporting years:
 

Child Care Access Means Parents in School (CCAMPIS) Program

 Annual Performance Report Form 

Section III-C: STUDENT REPORTED DATA 

INSTRUCTIONS: Enter responses to the following six questions. 

(Data below should be extracted from the institution's CCAMPIS student-parent survey data for this report year.) 

1. The number of student-parents who are enrolled and/or persisted at the institution because of

CCAMPIS grant assistance:

a. The number of student-parents enrolled at least halftime:

2. The number of student-parents reporting they would not be able to enroll and/or persist at the institution without the

CCAMPIS grant assistance:

Enroll Persist 

3. Enrolled but no longer needing CCAMPIS Support:

4. Enter the number of student-parents reporting that they would not be able to complete a certificate course of study or

graduate from the institution without the CCAMPIS grant assistance.

Certificate Undergraduate Degree Graduate Degree 

5. During hours of CCAMPIS provided child care, CCAMPIS student-parents were able to (check all reported responses):

Attend Class Have Additional Study Time Spend More Time in the Library/Computer Lab 

Take Earlier Classes Obtain Tutoring Assistance Participate in Group Study Projects or Meetings 

Take Later Classes Obtain Advising or Counseling Support Other 

6. How significant was the CCAMPIS grant support in enabling the student-parent to complete his/her degree or certificate:

(Please indicate the total number of Student-parents responding and the number of student-parents selecting each specific response.) 

Extremely Important: Not Important: Number of Student-Parents Responding 

Important: Not Helpful: 

Helpful: 

Please enter any additional information on CCAMPIS student-parents' academic outcomes such as the number of participants on 

track to graduate or transfer successfully, relevant employment outcomes, anecdotal stories of how CCAMPIS has enabled 

participants to succeed or the importance of the program to their feelings of acceptance and belonging, or other information: (max 

750 characters) 

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Child Care Access Means Parents in School (CCAMPIS) Program

 Annual Performance Report Form 

Section IV: PROJECT SERVICES and ACTIVITIES - TYPES of SERVICES RENDERED 

INSTRUCTIONS: Check all appropriate responses. Please indicate number of participants using these services, either directly (Institutionrun) or by contract with a third-party (Contracted). 

A. CCAMPIS Program-Funded Services Provided for Participants (check all that apply)

Type of Service Institution-Run Contracted Total number of 

Children 

Total Number of 

Participants 

1. Full-time Child Care Services

2. Part-time Child Care 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

11. Parenting Classes

12. Seminars

13. Meetings

14. Other

B. Fee Schedule for Participants and Non-participants (check all that apply)

Participants Non-Participants 

1. Sliding Fee Scale

2. Free Child Care Services

3. Standard-set Fee

4. Partial Tuition/Scholarship for Child

 Participants Non-Participants 

A. Total number of participants' infant children served: E. Total number of non-participants' served:

B. Total number of participants' toddler children served: F. Total number of non-participants' children

served:

C. Total number of participants' preschool children served:

D. Total number of participants' school age children served:

G. Total number of children of the employees

of the institution served:(Optional)

H. Total number of children of non-affiliated

members of the community served: (Optional)

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Child Care Access Means Parents in School (CCAMPIS) Program

 Annual Performance Report Form 

Section IV-C: PROJECT SERVICES AND ACTIVITIES - WAIT LISTS 

INSTRUCTIONS: Enter responses to the following four questions 

Waiting list for child care services for CCAMPIS-eligible children: 

1. Numbers of CCAMPIS-eligible children on wait list at the beginning of the 2022-23 academic year by age groupings:

Infants Toddlers Preschool School Age

2. Numbers of CCAMPIS-eligible children on wait list at the beginning of the 2023-24 academic year by age groupings:

Infants Toddlers Preschool School Age

3. Numbers of CCAMPIS-eligible children on wait list at the beginning of the 2024-25 academic year by age groupings:

Infants Toddlers Preschool School Age

4. Numbers of CCAMPIS-eligible children on wait list at the beginning of the 2025-26 academic year by age groupings:

Infants Toddlers Preschool School Age

5. Numbers of CCAMPIS-eligible children on wait list at the beginning of the 2026-27 academic year by age groupings:

Infants Toddlers Preschool School Age

Section IV- D: PROJECT SERVICES and ACTIVITIES - EARLY CHILDHOOD EDUCATION (ECE) COORDINATION 

INSTRUCTIONS: Enter responses to the following questions. 

D. Explain how the CCAMPIS Program-funded child care 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.) (max 2,000 characters) 

E. If the CCAMPIS Program does not coordinate with the institution's ECE program, please explain why. (max 2,000 characters) 

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Child Care Access Means Parents in School (CCAMPIS) Program

 Annual Performance Report Form 

Section V: CAMPUS AND COMMUNITY RESOURCES AND FUNDING 

INSTRUCTIONS: 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 entities, and amounts. 

Funding Type Total Amount Identify the resource(s) 

A. Local/Community Funding

B. State Funding

C. Institutional Student Activity Fees

D. Other Fees

E. Foundation Grants

F. Institutional Funds

G. In-Kind Contributions

H. Explain how funds have been leveraged from the institution's and/or local resources to support child care activities for lowincome (Pell grant-eligible/CCAMPIS Program-eligible) student-parents, and how the use of a sliding fee scale resulted in a high

number of such students obtaining a postsecondary education. (max 750 characters) 

I. Provide an explanation if funds have not been leveraged from the institution and/or local resources. (max 750 characters) 

J. Enrollment fees* What percentage of your total budget covers childcare costs?

ED-EP-0001.05 Page 8 of 17 

*This refers to the cost of childcare, that would otherwise be an out-of-pocket expense for low-income, Pell eligible student parents.
Child Care Access Means Parents in School (CCAMPIS) Program

Annual Performance Report Form

SECTION VI: CHILD CARE SERVICE ACCREDITATION AND LICENSING

INSTRUCTIONS: CCAMPIS provides funding for three categories of child care programs:

• INSTITUTION (CAMPUS) OWNED CHILD CARE SERVICES (VI-A)

• CONTRACTED-CHILD CARE SERVICES (VI-B)

• CONTRACTED HOME CHILD CARE SERVICE (VI-C)

Please provide accreditation and licensing information for each facility or provider operating under your institution’s CCAMPIS 

program by clicking the appropriate button below and completing the form generated. If you require additional forms you may press 

the corresponding button for that category more than once to add facilities or providers.

VI-A. Campus-Based Child Care Program (institution-run, on-campus or owned and operated by the institution):

VI-B. Contracted-Child Care Program:

VI-C. Contracted Home Child Care Program:
Child Care Access Means Parents in School (CCAMPIS) Program

Annual Performance Report Form

SECTION VI-A: INSTITUTION (CAMPUS) OWNED CHILD CARE SERVICES ACCREDITATION AND LICENSING

INSTRUCTIONS: Please provide responses to accreditation and licensing queries about the institution owned child care facilities 

used to support CCAMPIS student-parents with CCAMPIS funds. (To report additional facilities, click the Report Additional 

Facilities Button at the end of section VI-A)

Campus-Based Child Care Program (institution-run, on-campus or owned and operated by the institution):

1. Is the CCAMPIS Program-funded child care program accredited? Yes No

Facility Name:

Hours of Operation:

2. If the program is accredited? Date of Accreditation Accreditation Exp Date

Accreditation Agency Information

Agency Name:

Address: 

City: State: ZipCode:

3. If the program is not accredited and accreditation is not being sought, please explain. (max 2,000 characters)

a. Are you in the process of obtaining accreditation? Yes No

b. Check all the steps completed in the accreditation process:

Self-Assessment Awaiting Renewal Visit Applying for Candidacy

Awaiting Commission Decision Candidacy Status Deferred

Awaiting an Accreditation Visit

c. Estimated date accreditation is expected?

d. Accreditation Agency Information:

Agency Name:

Address: 

City: State: ZipCode:

4. If this is a new child care program (less than 3 years established), detail the actions taken, including a timeline to achieve the

goals set forth in the application. (max 2,000 characters)

5. Is the child care program and facility licensed by State and local licensing agencies? Yes No

a. Date of licensing

b. Expiration date of licensing

c. Licensing Agency Information:

Agency Name:

Address: 

City: State: ZipCode:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child Care Access Means Parents in School (CCAMPIS) Program 

Annual Performance Report Form 

SECTION VI-B: CONTRACTED-CHILD CARE SERVICES ACCREDITATION AND LICENSING 

INSTRUCTIONS: Please provide responses to the accreditation and licensing queries about the contracted-child care facilities, or 

programs used to support CCAMPIS student-parents with CCAMPIS funds. (To report additional facilities, click the Report 

Additional Facilities Button at the end of section VI-B) 

Contracted-Child Care Program: 

1. Is the CCAMPIS Program-funded child care program accredited? Yes No 

Facility Name: 

Hours of Operation: 

2. If the program is accredited? Date of Accreditation Accreditation Exp Date 

Accreditation Agency Information 

Agency Name: 

Address: 

City: State: ZipCode: 

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 the accreditation process:

Self-Assessment Awaiting Renewal Visit Applying for Candidacy 

Awaiting Commission Decision Candidacy Status Deferred 

Awaiting an Accreditation Visit 

c. Estimated date accreditation is expected?

d. Accreditation Agency Information:

Agency Name: 

Address: 

City: State: ZipCode: 

4. If this is a new child care program (less than 3 years established), detail the actions taken, including a timeline to achieve the

goals set forth in the application. (max 2,000 characters)

5. Is the child care program and facility licensed by State and local licensing agencies? Yes No 

a. Date of licensing

b. Expiration date of licensing

c. Licensing Agency Information:

Agency Name: 

Address: 

City: State: ZipCode: 
Child Care Access Means Parents in School (CCAMPIS) Program

Annual Performance Report Form

SECTION VI- C: CONTRACTED HOME CHILD CARE SERVICE ACCREDITATION AND LICENSING

INSTRUCTIONS: Please provide responses to accreditations and licensing queries about home child care providers used to support

CCAMPIS student-parents with CCAMPIS funds. (To report additional facilities, click the Report Additional Facilities Button at the 

end of section VI-C)

Contracted Home Child Care Program:

1. Is the CCAMPIS Program-funded contracted home child care program accredited? Yes No

Facility Name:

Hours of Operation:

2. If the provider is accredited? Date of Accreditation Accreditation Exp Date

Accreditation Agency Information

Agency Name:

Address:

City: State: ZipCode:

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 the accreditation process: 

 Self-Assessment Awaiting Renewal Visit Applying for Candidacy

 Awaiting Commission Decision Candidacy Status Deferred

 Awaiting an Accreditation Visit

c. Estimated date accreditation is expected?

d. Accreditation Agency Information:

Agency Name:

Address:

City: State: ZipCode:

4. If this is a new home child care program (less than 3 years established), detail the actions taken, including a timeline to 

 achieve the goals set forth in the application. (max 2,000 characters)

5. Is the child care provider and facility licensed by State and local licensing agencies? Yes No

a. Date of licensing

b. Expiration date of licensing

c. Licensing Agency Information:

Agency Name:

Address:

City: State: ZipCode: