Child Care Career and Professional Development Fund Application

Complete all information in the spaces provided. All applications must be accompanied by the required documentation. Incomplete applications will not be processed.

I have met with the CCCPDF Coordinator.YesNo

Application Type:

Personal Information

Last Name *

Middle Name

First Name *

Email Address *

Cell Phone *

Phone Number

Social Security Number *Without dash or space in between the numbers

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Gender

Race

Ethnicity

Age Range

Primary Language

I work in a Licensed Child Care Center in MarylandYesNo

PositionEnter your title/designation

Age Group(s)

License#

Center Name

Center Address:

Name of CCCPDF Participating College

Type of Degree

Course of Study/Major

Enrollment Information

Year

Projected Graduation

Year

Experience

Signed letter from current employer on letterhead OR Current Family Child Care license.
Signed letter from the previous employer on letterhead

Signed Letter(s)

College enrollment toward a degree in Early Childhood Education or related field

Letter of acceptance or other documentation from a Washington Adventist University, a CCCPDF participating University, including a declared major.
A professional development plan that includes course(s) and a timeline required to complete the degree.
Proof of Enrollment and (or) Transcript to verify 2 course completion

Proof of Enrollment

No file chosen

A Professional Development Plan (Required for new applicants)

No file chosen

*Signed CCCPDF Checklist (Required for all applicants)

No file chosen

REQUIREMENTS

Employment in child care - at least one year of child care experience AND work at least 10 hours per week.

College enrollment toward a degree in early childhood education or a related field

REQUIRED DOCUMENTATION

Family child care providers - A copy of current registration certificate
Child care center employees - Signed letter from current employer indicating, hire date, position, number of hours per week and age group.
Letter or other documentation of acceptance from Washington Adventist University
Professional development plan - list of courses and timeline required for degree completion.
A copy of CURRENT college transcript for courses completed (Continuation Only)

STATEMENTS AND ASSURANCES:

Select each item to indicate that you understand and agree with each statement.

SignaturePrint your name