Child	Care	Access	Means	Parents	in	School	Program

2014-15 Annual	Performance	Report (MS	Word)

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OMB No: 1840-0763

Expiration Date:

Child Care Access Means Parents in School (CCAMPIS) Program

2014-15 Annual Performance Report Form

Section I: Identification – Project Identification, Certification and Warning

(This section is expandable. Enter text in the gray box):

1. PR Award Number: P335A

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 (Double click box to enter response. Click on “Check” to 

enter response in appropriate box. Check one only)

2-year public institution 4-year public institution 

2-year private institution 4-year private institution 
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(Enter text in the gray box)

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 such collection displays a valid OMB control 

number. Public reporting burden for this collection of information is estimated to 

average 7 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 valid OMB control number for this 

information collection is 1840-0763. In accordance with Education Department General 

Administrative Regulations, § 80.40 Monitoring and reporting program performance, it is 

mandatory that grantees (shall) submit annual performance reports. Send comments 

regarding the burden estimate or any other aspect of this collection of information, 

including suggestions for reducing this burden, to the U.S. Department of Education, 

400 Maryland Avenue, S.W., Washington, DC 20210-4537 or e-mail 

ICDOCKETMGR@ed.gov and reference the OMB Control Number, 1840-0763. (Note: 

Please do not return the completed CCAMPIS APR to this address.)
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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 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 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).
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Academic Status — The registration status of participating CCAMPIS student-parents. 

This may be Enrolled (E), Graduated (G), Transferred (T) or Withdrew (W).

CCAMPIS Participation Status — Report whether or not the student-parent 

participated in the CCAMPIS program while enrolled at the institution or declined 

CCAMPIS 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 transfer/completion — 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 

degree or certificate) from your institution of higher education (IHE) while receiving 

CCAMPIS funded services. 

Degree/Certificate — The four categories for the participants’ degree/certificate are:

Certificate/Diploma (C), Associate’s (AA), Bachelor’s (BA), Teaching Credential (TC), 

and MS (Masters Degree). Only fill in this column if the participant completed/graduated 

from your institution while receiving CCAMPIS services.

Number of hours of child care provided — Record the number of hours of child care 

paid for with CCAMPIS funds for each parent participant. 

*Note: In the cases of dual-parents (married couples, shared parenting relationships), 

the child/ren should be counted for each student-parent independently. Child/ren and 

hours of child care are reported specific to each parent participant.

Number of children served — The number of the participants’ 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.

Childcare fees paid per month by student – The amount of out of cost pocket the 

student pays monthly.

CCAMPIS subsidy applied per month – The amount paid from the CCAMPIS grant 

monthly.
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Section III-A: Participant Demographics, Attendance, Persistence and Graduation

INSTRUCTIONS: The 2013-14 report must also reflect data reported by the institution 

for the 2010-11 and 2012-2013 periods. Grantees funded in 2010 should begin the 

Section III report by reporting data in the appropriate 2010-2011 section. Complete and 

submit in an Excel format. 

 Definitions for selection choices for each column are found on Excel pages 3-4.

 After selecting a report cell, an arrow will appear on the right. Left click on the 

arrow to see and make the appropriate selection choice. 

 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.

 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.
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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.

 Copy and complete additional Excel pages if necessary. Please submit Section 

III as an (electronic) Excel attachment.
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Section III-A: Participant Demographics, Attendance, Persistence 

and Graduation

Use the Excel Report to complete and submit this section
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Section III-B: Participant Demographics, Attendance, Persistence and Graduation

INSTRUCTIONS: Enter responses to the following eight questions by clicking in the 

gray text box. (Data reported below should be reflective of data reported on the Excel 

report.)

1. Total Number of CCAMPIS student-parents reported on the institution’s FY 13-14

APR that persisted at the institution in FY 14-15:

[ ]

2. Total Number of CCAMPIS student-parents attended/enrolled in FY 14-15:

[ ]

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

FY 14-15:

[ ]

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

FY 14-15:

[ ]

5. Total Number of CCAMPIS student-parents reported on the institution’s FY 14-15

APR expected to persist at institution into FY 15-16:

[ ]
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7. Total Number of CCAMPIS student-parents graduating from the 4-year institution

in the reporting year: 

Certificate [ ]

Diploma (BS/BA) [ ]

Diploma (MS/MA) [ ]

8. Total 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 Diploma (AA) [ ]

9. What was the grade point average of CCAMPIS student-parents enrolled at the 

institution during the reporting years:

FY 2013-14 FY 2014-15 FY 2015-16 FY 2016-17

Certificate 

seeking 

students

Degree 

seeking 

CCAMPIS 

students

Graduate 

Degree 

seeking 

students
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Section III-C: Student Reported Data

INSTRUCTIONS: Enter responses to the following five questions by clicking in the gray 

text box. (Data below should be extracted from the institution’s CCAMPIS studentparent 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: [ ]

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. 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

 Take earlier classes

Take later classes

Have additional study time

Spend more time in the library/computer lab
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Obtain tutoring assistance

Obtain advising or counseling support

Participate in group study projects or meetings

Other: 

6. How significant was the CCAMPIS grant support in enabling the student-parent to 

complete his/her degree or certificate (checks the appropriate response and indicate 

the number of students selecting that response):

Response Number of Student-Parents Responding

Extremely important [ ]

Important [ ]

Helpful [ ]

Not important [ ]

Not helpful [ ]

Please enter any additional information on CCAMPIS student-parents’ academic 

outcomes for past APR year (FY12-13) or prior reporting year (FY11-12), below:

 
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Section IV: Project Services and Activities – Types of Services Offered

INSTRUCTIONS: Check all appropriate responses. Do not indicate number of 

participants using these services, simply check whether or not you provided these 

services either directly (Institution-run) or by contract with a third-party (Contracted). 

Double click in the gray box to enter a response. Click on “Check” to enter response in 

the appropriate box. 

A. CCAMPIS Program Funded Services Provided for Participants

Check all that apply.

Type of Service Type of Service Contracted

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 (hourly)

11. Parenting classes

12. Seminars

13. Meetings

14. Other (specify): 
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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

A. Total number of participants’ infant children served:

B. Total number of participants’ toddler children served:

C. Total number of participants’ preschool children served:

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

Non-Participant:

E. Total number of non-participants served: 

F. Total number of non-participants’ children served: 

Section IV-C: Project Services and Activities - Wait Lists

INSTRUCTIONS: Enter responses to the following four questions by clicking in the gray 

text box. 

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

1. Numbers of CCAMPIS-eligible student-parents and children on wait list at the 

beginning of the 2013-14 academic year by age groupings: 

Infants [ ]

Toddlers [ ]

Preschool [ ]

School Age [ ]
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2. Numbers of CCAMPIS-eligible student-parents and children on wait list at the 

beginning of the 2014-15 academic year by age groupings:

Infants [ ]

Toddlers [ ]

Preschool [ ]

School Age [ ]

3. Numbers of CCAMPIS-eligible student-parents and children on wait list at the 

beginning of the 2015-16 academic year by age groupings: 

Infants [ ]

Toddlers [ ]

Preschool [ ]

School Age [ ]

4. Numbers of CCAMPIS-eligible student-parents and children on wait list at the 

beginning of the 2016-17 academic year by age groupings:

Infants [ ]

Toddlers [ ]

Preschool [ ]

School Age [ ]
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Section IV-D: Project Services and Activities - Early Childhood Education (ECE) 

Coordination 

INSTRUCTIONS: Enter responses to the questions below by clicking in the gray 

(expandable) text box. 

D. In the gray text box provided below, please 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.) Please 

use an additional page (with the appropriate section header) to respond.

 

E. If the CCAMPIS Program does not coordinate with the institution’s ECE program, 

Please explain why.

 

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. Enter 

responses by clicking in the gray (expandable) text box.

A. Local/Community Funding: Total $ ________ / Identify the resource(s):

 

B. State Funding: Total $ ________ / Identify the resource(s):

 

C. Institutional Student Activity Fees: Total $ ________ / Identify the resource(s):

 
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D. Other fees: Total $ ________ / Identify the resource(s):

 

E. Foundation grants: Total $ ________ / Identify the resource(s):

 

F. Institutional funds: Total $ ________ / Identify the resource(s):

 

G. In-kind contributions: Total $ ________ / Identify the resource(s):

 

H. Below, explain how funds have been leveraged from the institution’s and/or local 

resources to support child care activities for low-income (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:

 

I. If funds have not been leveraged from the institution and/or local resources, please 

provide a response in the text box below: 

 
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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 studentparents with CCAMPIS funds. Enter responses by either clicking in the gray area to 

check the appropriate response or by entering text in the (expandable) text box. (To 

report additional facilities, copy Section IV-A and attach additional page(s) to this 

section of the APR.)

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:

2. If the program is accredited:

a. Date of accreditation (mm/dd/year):

b. Expiration date of accreditation (mm/dd/year):

c. Accrediting Agency – Name and Address:

 

3. If the program is not accredited and accreditation is not being sought, please explain 

why in the text box below:

 

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
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Awaiting an Accreditation Visit

Awaiting Renewal Visit

Awaiting Commission Decision

Deferred

c. Estimated date accreditation is expected (mm/dd/year):

d. Accrediting Agency – Name and Address:

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, in 

the text box below.

 

5. Is the child care program and facility licensed by State and local licensing 

agencies? Yes No

a. Date of licensing (mm/dd/year):

b. Expiration date of licensing (mm/dd/year):

c. Licensing Agency – Name and Address:
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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. Enter responses by either clicking in the gray 

area to check the appropriate response or by entering text in the (expandable) text box.

(To report additional facilities, copy Section IV-B and attach additional page(s) to this 

section of the APR.)

Contracted-Child Care Program:

1. Is the CCAMPIS Program funded contracted child care program accredited? 

Yes No Facility Name:

2. If the program is accredited:

a. Date of accreditation (mm/dd/year):

b. Expiration date of accreditation (mm/dd/year):

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 (mm/dd/year):
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 Deferred

 c. Estimated date accreditation is expected:

d. Accrediting Agency – Name and Address:

 

4. If this is a new child care program (less than 3 years established), detail the 

actions taken, including a timeline to achieve goals set forth in the application regarding 

licensing and accreditation:

 

5. Is the child care program and facility licensed by the State and local licensing 

agencies? Yes No
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Section VI-C: Contracted Home Child Care Services 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. Enter responses to the questions below by either clicking in the gray 

to check the appropriate response or by entering text in the (expandable) text box. (To 

report additional facilities, using the section title as a header, attach additional pages to 

this section of the APR.)

Contracted Home Child Care Program:

1. Is the CCAMPIS Program funded contracted home child care program accredited? 

Yes No Name of Provider:

2. If the provider is accredited:

a. Date of accreditation (mm/dd/year):

b. Expiration date of accreditation (mm/dd/year):

c. Accrediting Agency – Name and Address:

 

3. If the provider is not accredited:

a. Is the provider 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
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Awaiting Commission Decision 

 Deferred

c. Estimated date accreditation is expected 

d. Accrediting Agency – Name and Address:

4. If this is a new home child care program (less than 3 years established), detail 

the actions taken, including a timeline and mentoring provided to achieve the goals 

set forth in the application below:

 

5. Is the child care provider and home licensed by the State and local licensing 

agencies? Yes No

Licensing Date (mm/dd/year): 

Licensing Expiration Date (mm/dd/year): 

Name of the licensing agency/ agencies: