Carl Perkins Child Care Program Application

Due to some technical errors, the applications have been updated for the current term.  If you are accessing the application via old links, the forms may not be forwarded correctly.  Please visit for updated applications.


Do any of the following unique and/or special circumstances apply to you? (Check any or all that apply)
Class Schedule (check all days that apply)

Release of Records

I approve release and/or review of my personal school records. I understand fully that my attendance in college courses must be in compliance with school policy and that I may be dropped from the Child Care Program at any time if my attendance is poor.

I understand that Child Care is only available during the time that I am in class. If I drop any of my college courses, for any reason, I must notify the Dean’s Office immediately. If this affects my Child Care status, the award will be modified accordingly.

Failure to report any changes will result in immediate termination from the program.

Inconsistent class attendance will result in termination from the Child Care Program.

If at any time I become ineligible under the terms of the program, or if funds are withdrawn from the grant program, I understand that I will be responsible for any transportation charges incurred after the date I become ineligible or after the funds are withdrawn.

I must maintain, each semester, a GPA of 2.0 or higher as well as an overall GPA of 2.0 or higher.

I fully understand, confirm, and agree to the above conditions for services through the Child Care Program.

I have read and agree to comply with the Child Care Program provisions. I understand that failure on my part to comply with any of the provisions could result in loss benefits provided. 

Acceptance of Award

I wish to apply for the Child Care Assistance Program at San Jacinto College. I have read the Rules and Regulations and have fulfilled the requirements that apply to me.

Please acknowledge you have read the statement below by checking the box provided next to each statement.

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