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CCAMPIS Grant Application

(Child Care Access Means Parents in School)

Child Care Subsidy for University of Utah Student Parents

  • Child must be enrolled in a nationally accredited program to apply.
  • In order to be considered for enrollment in the CCAMPIS Program, all information must be provided.
  • New applications are due each semester.

Program Information
Indicates a required field.
  1. Are you currently enrolled in a child care program?
  2. Have you received an acceptance letter from the child care program for the semester you are applying for the subsidy?
  3. Have you attended a Financial Assistance for Child Care Orientation?
Parent 1 (Student) Information
  1. (e.g. xxx-xxx-xxxx)
  2. (e.g. u0123456)
  3. Have you completed a FAFSA form?
  4. Are you receiving a Pell Grant?
  5. Gender
  6. Ethnicity
  7. Citizenship
  8. If permanent resident,
  9. (e.g. xxx-xxx-xxxx)
  10. Do any other adults live in the household?

Parent 2 Information
  1. Parent 2 Address
  2. Is Parent 2 a student?
  3. (e.g. u0123456 or enter N/A if Not U of U Student)
  4. Gender
  5. Ethnicity
  6. Citizenship
  7. If permanent resident,
  8. (e.g. xxx-xxx-xxxx)

Child's/Children's Information

Please, only provide information for the child(ren) that will be enrolled in child care this semester.

First Child
  1. Ethnicity
  2. Child lives with

Second Child
  1. Ethnic Origin
  2. Child lives with

Third Child
  1. Ethnic Origin
  2. Child lives with

Income Resources

All applicants, please fill out this section as this information is required to determine eligibility and subsidy award.

Report total GROSS income for each item listed below.

  1. Income Resources U of U Student Parent Parent 2/Guardian 2
      Annual Amount $ Annual Amount $
    Money, wages or salary
    Net income from self-employment
    Social Security income
    Dividends, interest income
    Public assistance/welfare and/or food stamps (Horizon card)
    DWS child care assistance, etc.
    Pension and annuities
    Unemployment
    Disability Insurance
    Worker’s Compensation
    Alimony received
    Child support received
    Veteran’s pensions
    Academic Financial Assistance U of U Student Parent Parent 2/Guardian 2
      Annual Amount $ Annual Amount $
    Grants (Pell, SEOG, and others)
    Scholarships
    Stipends
    Tuition reduction
    Tuition reimbursement
    Student loans - for information only, will not be counted in total income resources

Family Information for Household
  1. Children's Ages

Additional Documentation

Additional documentation is required to complete the CCAMPIS Grant Application.

  • Please explain your financial circumstances in detail so that we may better understand your need.
  • A class schedule for each parent who is a student at the university.
  • A Screen shot of the 'Financial Aid Status' from CIS for each parent who is a student at the university.
  • Two current check stubs or letter from employer stating earnings (for each parent/step-parent/guardian in the home)
  • Copy of your current tax return (first two pages of form 1040/1040A, not the attachments)
  • Current documentation for all other sources of income (unemployment, child support, alimony, public assistance/welfare, food stamps, child care assistance from DWS or other sources, etc.)
  • Current SAR (Student Aid Report from www.fafsa.ed.gov) for parent/step-parent/guardian living in the household

Submit documentation via email to Center for Child Care and Family Resources


Confirmation
Last Updated: 7/22/20