CCAMPIS Application Form

Please use your Electronic Signature after reading the below statements. *

I understand the goal of the CCAMPIS program is to assist me with child care expenses so that I can remain enrolled at UF, and succeed in completing credits towards my degree program.

My participation in the program is dependent upon my successful completion of semester credits on a consistent basis towards earning my degree.

If I drop/withdraw classes during the semester and/or fall below part-time (6 credits), I agree to contact the CCAMPIS program coordinator immediately to discuss if these changes will affect my eligibility.

I understand I will be responsible for paying a portion of my child's childcare cost to the Baby Gator and must pay any outstanding balance by the end of the semester. Failure to pay this balance will result in a hold being placed on my student account.

I understand that I will be responsible for 100% of all child care fees charged by Baby Gator in the event I am no longer meet the eligibility requirement for the CCAMPIS program.

I understand that I will be required to complete regular program evaluations, and this is essential to my ongoing funding through the CCAMPIS program.

I understand that I am required to attend semesterly Connection Check-In meetings, participate in at least one family involvement initiative at the center each semester, and provide a copy of my class schedule each semester.

I agree to provide Baby Gator Child Development & Research Center additional supporting documentation (financial, academic, or otherwise) upon request in order to determine eligibility of enrollment in the CCAMPIS program.

I understand that aggregate information, but no personal information, will be shared with the U.S. Department of Education in Washington D.C., who funds this program.

I agree to complete a post-graduation survey, even after my child is no longer receiving services at Baby Gator pertaining to program evaluation including but not limited to my employment, income, and quality of care/services.

I understand submission of an application DOES NOT guarantee approval and assistance is based on available funds and program eligibility.

I have read and understand the above guidelines and program requirements and hereby certify that the information in this application is complete and accurate to the best of my knowledge. I understand and accept the obligations of the program and will notify Baby Gator in writing of any changes in the information provided on this application within 10 days of the change. Changes may include, but are not limited to my college enrollment, credit hours, and financial status. I understand this application does not guarantee space available or enrollment in the Baby Gator centers.

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.