## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

1 **OMB No: 1840 -**  **0763 Expiration Date:**  

### Child Care A**ccess Means Parents in School (CCA MPIS) Program** 

**201 4**  **- 1**  **5 An**  **nual 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 publ ic institution 2 - year private institution 4 - year private institution

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

2 ( Enter text in the gray box) B. Certification: W e 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

________________________________ S ignature ________________________________ Signature

________________________________ ________________________________ Date Date C. W arning: Any person who knowingly makes a false statement or misrepresentatio n 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 an d 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 u nless 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 m aintaining 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 Administrati ve Regu la tion s , § 80.40 Monitori ng and reporting program performance, it is mand a tory 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 . , Wa shington, DC 202 10 - 4 537 or e - mail ICDOCKETMGR@ed.gov and reference the OMB Control Number, 1840 - 0763 . ( Note: Please do not return the completed C CAMPIS APR to this address. )

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

3 **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 recei ve 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 H EOA, 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 ea ch 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 l ives 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 G rant (E). Additionally , students may be coded as Low Income Graduate Student ( LIG) , or Low Income Foreign Student (LIF).

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

4 **Ac ademic Status**  — The registration status of participating CCAMPIS student - parents. This may be Enrolled (E), Graduated (G), Transferre d (T) or Wi thdrew (W ). **CCA MPIS 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 selecti on codes is : Enrolled Participating in CCAMPIS (EPC) , Enrolled but Declined CCAMPIS Participation (EDPC) or W ithdrew From CCAMPIS Participation (WFCP ). **Non -**  **participant** — Individua l 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 h igher 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 (T C), 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 c**  **hild c**  **are 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. **CCA MPIS subsidy** 

**applied per month** – The amount paid from the CCAMPIS grant monthly.

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

5 **Section III -** **A :**  **Participant Demog raphics, Attendance, Persistence and Graduation**  INSTRUCTIONS: The 20 13 - 1 4 report must also reflect data reported by the institution for the 20 1 0 - 1 1 and 201 2 - 201 3 periods. Grantees funded in 2010 should begin the Section III report by reporting data in t he 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 “W inter” 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” c olumn , 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 “W inter” column blank.
 However, if you have four academic terms during an academic year (AY ) – running fa ll 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.

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

6 o “T” designates a particip ant 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 “W FCP” designates a participant that withdrew from the institution and was withdrawn from CCAMPIS program participation.
 Copy and c omplet e additional Excel pages if necessary. Please submit Section III as a n (electronic) Excel attachment.

## Child	Care	Access	Means	Parents	in	School	Program 201 4 - 1 5 A nnual P erformance R eport (MS	Word)

7 

# Section III **- A: Participant Demographics, Attendance, Persistence**  **and Graduation**

**Use the Excel Report to complete and submit this section**

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 Annual	Performance	Report (MS	Word)

8 **Section III -**  **B :**  **Participant Demographics, Attendance ,**  **Persistence and Graduation** INSTRUCTIONS: Enter response s to the following eight questions by clicking in the gray text box. ( Data reported below should be reflective o f data reported on the Excel repor t. ) 1. Total Number of CCAMPIS student - parents reported on the institution ’ s FY 1 3 - 1 4 APR that persisted at the institution in FY 1 4 - 1 5 : [ ] 2. Total Number of CCAMPIS student - parents attend ed /enroll ed in FY 1 4 - 1 5 : [ ] 3. Total Number of CCAMPIS stu dent - parents that graduated from the institution in FY 1 4 - 1 5 : [ ] 4 . Total Number of CCAMPIS student - parents that withdrew from the institution in FY 1 4 - 1 5 : [ ] 5 . Total Number of CCAMPIS student - parents reported on the institution’s FY 1 4 - 1 5 APR ex pected to p ersist at institution into FY 1 5 - 1 6 : [ ]

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

9 7 . Total Number of CCAMPIS student - parents graduating from the 4 - year institution in the report ing year : Certificate [ ] Diploma (BS/BA) [ ] Diploma (MS/MA) [ ]
8 . Total Number of CCAMPIS student - parents that transfer red from a 2 - year institution to a 4 - year institution in this report ing year : Certificate [ ] Wi th a Diploma (AA) [ ] Wi thout Diploma (AA) [ ] 9 . Wh at wa s the grade point average of CCAMPIS student - parents enrolled at th e institution during the report ing years :

FY 20 1 3 - 1 4 FY 20 1 4 - 1 5 FY 20 1 5 - 1 6 FY 20 1 6 - 1 7 Certificate seeking students Degree seeking CCAMPIS students Graduate Degree seeking students

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

10 **Section III -**  **C :**  **Student Reported Data** INSTRUCTIONS: Enter response s to the following f ive 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 . T he number of student- parents who are enrolled and /or persis ted at the insti t ution because of CCAMPIS g rant assistance: [ ] 2 . The number of student - parents report ing they would not be able to enroll and /or persist at the institution without the CCAMPIS g rant assistance : Enroll [ ] Persist [ ] 3. Enrolled b ut no longer needing CCAMPIS support: [ ] 4 . The number of student - parents report ing that they would not be able to complete a certificate course of study or graduate from the institution without the CCAMPIS g rant assistance. Certificate [ ] Underg raduate 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

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

11 Obtain tutoring assistance Obtain advising or counseling support Participate in grou p study projects or meeting s Other: 6 . How significant was the CCAMPIS grant support in enabling the student - parent to complet e h is/h er degree or certificate (checks the appropriate response and indicate the nu mber of students selecting that response) : Response Number of Student - Parents Responding 

### Extremely important [ ] 

### Important [ ] 

### Helpful [ ] 

### Not important [ ] 

### Not helpful [ ] Please enter any additional informat ion on CCAMPIS student - parents ’ academic outcomes for past APR year (FY1 2 - 1 3 ) or prior report ing year (FY 1 1 - 1 2 ) , below:

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

12 **Section IV :**  **Project Services and A ctivities**  **– Ty**  **pes of Services Offered** INSTRUCTIONS: Check all appropriate responses. Do not indicate number of participants using these services, simply check whether or not you provide d these services eithe r 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. We ekend services 7. Summer term services 8. 24 - ho ur services 9. Emergency services 10. Drop - in services (hourly) 11. Parenting classes 12. Seminars 13. Meetings 14. Other (specify):

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

13 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 :**  **Pr oject Services and A** **ctiv ities**  **- Wait Lists**  INSTRUCTIONS: Enter respons es to the following four questions by clicking in the gray text box. Wa iting list for child care services for CCAMPIS - eligible s tudents : 1. Numbers of CCAMPIS - eligible student - parents and children on wait list at the beginning of the 201 3 - 1 4 academic year by age groupings: Infants [ ] T oddlers [ ] Preschool [ ] School Age [ ]

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

14 2. Numbers of CCAMPIS - eligible student - parents and children on wait list at the beginning of the 201 4 - 1 5 academic year by age groupings: Infants [ ] Toddlers [ ] Preschool [ ] School Ag e [ ] 3. Numbers of CCAMPIS - eligible student - parents and children on wait list at the beginning of the 201 5 - 1 6 academic year by age groupings : Infants [ ] Toddlers [ ] Preschool [ ] School Age [ ] 4. Numbers of CCAMPIS - eligible studen t- parents and children on wait list at the beginning of the 201 6 - 1 7 academic year by age groupings: Infants [ ] Toddlers [ ] Preschool [ ] School Age [ ]

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

15 **Section IV -**  **D :**  **Project Services and A ctiv**  **ities -**  **Early Childhood Education (ECE)**  **Coordin ation**  INSTRUCTIONS: Enter responses to the question s below by clicking in the gray (expandable) text box. D. In the gray text box provided below, p lease e xplain how the CCAMPIS Program funded child care services have coordinated with the i nstitution’s Early Childhood Education (ECE) program. (The ECE program refers to the i nstitution’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, includin g 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 entit ies, 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):

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

16 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. B elow, e xplain how funds have been leveraged from the i nstitution’s and /or local resources to support child care activities for low- income (Pell g rant - 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 lo cal resources, please provide a response in the text box below:

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

17 **Section VI -** **A :**  **Institution (Campus) Owned Child Care Services A** **ccreditation and Licensing**  INSTRUCTIONS: Please provide responses to accreditation and licensing quer ies 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 ( i nstitution - run, on - campus or owned and operated by the institution) : 1. Is the CCAMPIS Program funded child care prog ram 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 wh y 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

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

18 Awaiting an Accre ditation 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 licensin g ( mm/dd/year): b. Expiration date of l icensing ( mm/dd/year): c. Licensing Agency – Name and Address :

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

19 **Section VI**  **- B**  **: Contracted**  **- Child Care Services A** **ccreditation 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 pro gram 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):

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

20 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 goal s 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

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

21 **Section VI**  **- C**  **: Contracted**  **Home Child Care Services A** **ccreditation and Licensing** INSTRUCTIONS: Please provide re sponses 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 enter ing 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 proce ss 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

## Child	Care	Access	Means	Parents	in	School	Program

201 4 - 1 5 A nnual P erformance R eport (MS	Word)

22 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 mento ring 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 a gency / a gencies :