PVCCAMPIS Application

PVCC Child Care Access Means Parents in School Collaborative Program Application Form
Academic Year
CCAMPIS Agreement
Please Indicate That You Have Read, Understand and Agree to the Following

1. Applicant Information


2. Student Demographic Information

Are you connected to the military?

3. Academic Information

Academic Plan
Academic Load

4. Child Care Needs

Indicate the different types child care arrangements you currently use
Do you currently use a child care facility for your children?

5. Income Information

Are you currently receiving financial assistance for your child care expenses?

Please note: Submission of CCAMPIS application DOES NOT guarantee entry into the program. If approved, student will be contacted by PV CCAMPIS Program Director to schedule an interview

IMPORTANT: Only those with a lawful presence in the U.S. may qualify for MCCCD scholarships or federal financial aid.  Any information you provide about your legal status when you apply for financial aid or scholarship may be subject to mandatory reporting to federal immigration authorities under AZ law.  Students applying for MCCCD scholarships or federal financial aid must have ONE of the following documents on file in the Admissions office as evidence of lawful presence in the U.S. at time of submission.

  1. An Arizona driver license issued after 1996 or an Arizona non-operating identification license.
  2. A birth certificate or delayed birth certificate issued in any state, territory or possession of the United States.
  3. A United States certificate of birth abroad.
  4. A United States passport.
  5. A foreign passport with a United States visa.
  6. An I-94 form with a photograph.
  7. A United States citizenship and immigration services employment authorization document or refugee travel document.
  8. A United States certificate of naturalization.
  9. A United States certificate of citizenship.
  10. A tribal certificate of Indian blood.
  11. A tribal or bureau of Indian affairs affidavit of birth.
  12. Tribal members, the elderly and “persons with disabilities or incapacity of the mind or body,” may submit certain types of documentation under Section 1903 of the federal Social Security Act (42 United States Code §1396b, as amended by Section 6036 of the Federal Deficit Reduction Act of 2005)

By submitting this application, I swear under penalty of perjury that the document(s) that I have submitted to demonstrate lawful presence in the United States are true.