Grant Application

Child Care Access Means Parents in School

CCAMPIS is a federally funded initiative to assist eligible student- parents in completing their education by subsidizing the cost of childcare at the Kanis Child Development Center. 

Completing this application does not guarantee funding or enrollment in the Kanis Child Development Center. 

If you see this don't fill out this input box.

Applicant information

Application Type

NewReturning

*Semester

*First Name:

*Last Name:

*Birth Date

*Primary Language

Contact Information

*First Name

*Last Name

*Address

*City

State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*Zipcode

*Phone

*Email Address:

*CSU Student ID#

Gender

MaleFemale

Single Parent

YesNo

Ethnicity

Please Select American Indian/Alaskan Native Asian Black or African-American Hispanic/Latino Hawaiian/Pacific Islander White Two or more races

CSU Enrollment Status

Full Time Student

YesNo

First Generation Student

YesNo

*Credits Completed

*Current GPA

*Expected Graduation Year

*Credit Hours (During Grant Semester Applying For)

*Major

Financial Aid

*Other Grants you are receiving

Completed FAFSA

YesNo

*Financial Assistance

Children Information

*Center-base (3-5 years old)

*After School Program (6-12 years old)

Any of your children have special needs

YesNo

Legal Parent

YesNo

Submit  

By submitting  I certify that all of the information on this form is true and complete to the best of my knowledge. I understand that I will need to provide proof of the information stated in this form for verification by the Kanis CDC.