HEAD START of Greater Dallas, Inc.
College Course Request Form
(For Delegate Agency staff only)
This form is required for all delegate agency staff who are requesting to take a college
course and want HEAD START of Greater Dallas (HSGD) funds for all or any part of the
fees or books. HSGD will need to use your eConnect user name and eConnect password
that you will have to set up through the Dallas County Community College District web
page, www.dcccd.edu, - eConnect. Your personal information will be protected by HSGD,
and will only be used to validate your eligibility status. If at any time you no longer want
HSGD to have access to your college records, all you need to do is change your eConnect
password and we will no longer have access to your information, and we will no longer
fund your college education if we cannot access your records.
If you want to take a college course toward a CDA or Associate Degree in Child
Development and you have never taken a course at any of the Dallas County Community
College District (DCCCD) campus' you have to go online to www.dcccd.edu and complete
their application for enrollment form. You must be accepted by DCCCD and in good
standing to register for a course. Also, if you have been a student in the DCCCD, but have
not attended a class in a year or more you will need to reapply.
For students who have taken courses for their CDA or Associate Degree that have been
paid for by HSGD, please go the eConnect link on the DCCCD.edu web page, pull up your
grades, copy the grades and fax this to Tim Devaney (972) 296-6309 along with this
College Course Request form.
For staff who have not taken any courses paid for HSGD indicate on the form that you are
“New” to this program.
Once this information is processed in Training you will be emailed a letter. When you get
this letter make three copies: one to take to the college business office for payment of
tuition, the second copy to take to the bookstore (Follets Bookstore, on campus) for
payment of your book(s), and the third copy is for you personal files.
At this time college course funding is only available to teachers who are seeking their CDA
or the Associate Degree in Child Development. All courses requested must be included on
the Child Development Associate Degree plan. There are some work related exceptions
that must be approved by Tim Devaney or Cinithia Melton prior to sending this form. If you
have any questions, please call or email Tim Devaney (972-283-6428),
tdevaney@hsgd.org or Cinithia Melton (972-283-6427), cmelton@hsgd.org.
(As of October 31, 2007, previous College Course Request forms will not be accepted.)
Fax form to HSGD Training Department – 214-206-4363
Please fill out this College Course Request form completely.
It is required that you go online (eConnect) and check your grades to verify that you have no failures,
withdrawals or incompletes for any college courses that were funded through Head Start of Greater Dallas
(HSGD). If you have already taken a course through DCCCD, you are required to provide your eConnect ID
and password if you want HSGD funding.
Did you verify that you have checked your records and have no failures, withdrawals or
incomplete courses that have been paid for by HSGD?
yes
no
Print all information clearly
Name _______________________
Center __________________________ (give full name)
Job Title __________________
Hire Date ___/_____ (month/year)
eConnect user name ___________________
Note: remember to fax your grades from eConnect along with this form, or if you have
not taken any courses paid for by HSGD check “New”
Social Security Number ___________________________
Supervisor’s Signature ________________________________
Date ___/___/______
If you have taken a course with DCCCD and you do not include your eConnect ID this form will
automatically be rejected. If you have not taken a course with DCCCD enter the word “new” for your
eConnect ID.
Please fill every blank in the box or this request will be denied.
First Course
Name of Course ____________________________________________
(examples: Child Abuse and Neglect, Developmental Math)
Course Number ______________ (example: CDEC 2301)
Starting date of course (month/year) ___/______
Campus offering course
Brookhaven,
Eastfield,
Cedar Valley,
Mountain View,
North Lake,
Richland,
Other
Location of course if not on campus _____________________________
El Centro,
Second Course
Name of Course ____________________________________________
Course Number ______________
Starting date of course (month/year) ___/______
Campus offering course
Brookhaven
Eastfield
Cedar Valley
Mountain View
North Lake
Richland
Other
El Centro
Location of course if not on campus _____________________________
(Only fax this page to Training (214-206-4363) unless there is a third course requested.)
Third Course
Name of Course ____________________________________________
Course Number ______________
Starting date of course (month/year) ___/______
Brookhaven
Eastfield
Cedar Valley
Campus offering course
Mountain View
North Lake
Richland
Other
Location of course if not on campus _____________________________
(Only fax (214-206-4363) the pages that you write on.)
February 1, 2010 – Tim C: Forms: Delegate College Course Request Form
El Centro