CYFD Supplemental Application
TBA
Application
ELIGIBILITY DETERMINATIONS
ELIGIBILITY DETERMINATIONS Please know that you will need to provide a completed W9, Unoffical Transcript, and at least six months of current pay stubs. Disclaimer: you will be issued a 1099 at the end of each tax year for all monies received.
Please select one of the following:
- Select -
I am a Teacher or Teacher Assistant working in a CYFD Licensed or Registered Program
I am an Assistant Teacher working in a Head Start Program
I am a Teaacher working in an Early Head Start Program
I am a Teacher Assistant working in a CYFD funded PreK classroom
None apply to me
Please select one of the following:
- Select -
I have 5 credits or more in Early Childhood Education
I have 70 hours of well rounded course work
None apply to me
Do you earn more than 16$ an hr before taxes?
- Select -
Yes
No
GENERAL INFORMATION
Social Securtiy/ITIN Number
First name
Middle name
Last name
Maiden name (if applicable)
Mailing address
City
County of Residence
State
Zip
Home phone
Cell phone
Email address
Date of birth
Gender (M/F)
Male
Female
Ethnicity
Black/African American
Asian American/Pacific Islander
Other
Biracial
White/European American
Hispanic American/Latino/Latina
American Indian (tribe)
Do you prefer to be contacted by a Spanish speaker?
- Select -
Yes
No
Have you previously applied to the Wage Supplement Program?
- Select -
Yes
No
EMPLOYMENT INFORMATION
Child care program name
County
Employment start date
Program Mailing Address
Program mailing address-City
Program mailing address-State
Program mailing address-Zip
Program phone
Director/Administrator Name
Director/Administrator Email
Please indicate funding sources your classroom/home receives (Check all that apply)
CYFD Pre-K
CYFD Head Start
CYFD
None of the above
Don't know
How many months per year do you work in your program?
- Select -
1
2
3
4
5
6
7
8
9
10
11
12
Which months do you have off? (if applicable, check all that apply)
May
June
July
August
Other
Please indicate how much you are paid yearly:
Are you currently a member of the NMERB (New Mexico Education Retirement Board)?
- Select -
Yes
No
EDUCATIONAL BACKGROUND
High School information (required)
- Select -
High school diploma
GED
Adult high school diploma
Currently enrolled
None
Year of graduation
Colleges attended
- Select -
Currently Not Enrolled
Central New Mexico Community College
Clovis Community College
Doña Ana Community College
Eastern New Mexico - Portales
Eastern New Mexico - Roswell
Eastern New Mexico - Ruidoso
Luna Community College
New Mexico Highlands University
New Mexico Junior College
New Mexico State University
New Mexico State University - Alamogordo
New Mexico State University - Grants
Northern New Mexico College
San Juan College
Santa Fe Community College
University of New Mexico
University of New Mexico - Gallup
University of New Mexico - Taos
University of New Mexico - Valencia
Western New Mexico University
Other Option
Year graduated/anticipated graduation date
Degrees earned
No degree earned
CDC
AA/AAS
BA/BS
MA/MS
Have you earned any college credits?
- Select -
No
3-12 credits
15-27 credits
29-40+ credits
Are you currently enrolled in early childhood coursework at a college or university?
- Select -
Yes
No
Are you currenly participating in the CYFD Early Childhood Scholarship Program?
- Select -
Yes
No
Certificates and Credentials (Check all that apply)
None Earned
45 hours entry level class in Early Childhood
New Mexico Child Development Certification
Child Development Associates Credential (CDA)
One Year Vocational Certificate
Other
List other
Do you have an Early Childhood Teaching License?
- Select -
Yes (If you have a teaching license in early childhood you will be asked to scan and email us a copy.)
No
Other
STATEMENT OF AFFIRMATION
I attest that the information provided on this application and the supporting documentation is true to the best of my knowledge.
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Process