Parent declaration for early education funding
Please note this form cannot be completed through our website it must be completed as a paper copy which must then be returned to school for our records. We cannot offer a nursery place unless we have the original paper form on record in school. We have provided this so that parents can read the text of the form in their own language alongside the official form which you need to complete.
We hope this helps you to understand the process.
|Child’s legal first name(s):||Child’s legal family name:|
|Date of Birth:||Male/Female:|
|Documentary proof of date of birth
(eg Birth Certificate, Passport)
|Document recorded by (name of staff member) Date document recorded
|Residence Order / Special Guardianship
|Funding Start date
Please provide the following information to enable the local authority to confirm eligibility for 2 year old funding, 30 hours and EYPP
|Parent / Carer 1||Parent / Carer 2|
|Legal Forename:||Legal Forename:|
|Legal Family Name:||Legal Family Name:|
|Date of Birth:||Date of Birth:|
|NI or NASS Number:||NI or NASS Number:|
|**30 hours eligibility code**|
|**2 Year Old Funding Reference**|
Setting and attendance details
- You need to agree and complete this Declaration Form with each setting your child attends for their early education entitlement of 15 or 30 hours per week in order to ensure that funding is paid fairly between
- For 3 and 4 year olds – your child can attend a maximum of 2 sites in a single day and if your child attends more than 1 setting we will split the funding fairly between the
- For 2 year olds – your child can attend 1 setting only
- Parents / carers are required to give 4 weeks’ notice to their early year’s provider before being able to access funding at an alternative
- Your commitment to your child’s consistent attendance at their placement is of the utmost importance. In the event that your child cannot attend their sessions for any reason (illness ), you must telephone the setting to inform them of your child’s absence. You may be contacted by a member of the Early Help Team to support you and your child back into placement. Ultimately, poor attendance may result in the placement being withdrawn.
My child is attending the following settings:
|Please enter total Early Education Funded hours attended per day||Total number of actual hours attended per week||Total number of f u n d e d hours per week||Number of weeks per year
|Total Daily Free Hours Attended|
Early Years Pupil Premium (EYPP) – see note 4 on page 4
The Early Years Pupil Premium (EYPP) is an additional sum of money paid to childcare providers for 3 and 4 year old children of families in receipt of certain benefits. This funding will be used to enhance the quality of their early years’ experience by improving the teaching, learning, facilities and resources, with the aim of impacting positively on your child’s progress and development. For more information please speak to your childcare provider.
Disability Access Fund Declaration – see note 5 on page 4
3 and 4 year old children who are in receipt of child Disability Living Allowance and are receiving the free entitlement are eligible for the Disability Access Fund (DAF). DAF is paid to the child’s early years setting as a fixed annual rate of £615 per eligible child and will be used for equipment and resources.
Is your child eligible and in receipt of Disability Living Allowance (DLA)?
- Yes – Evidence attached
If your child is splitting their free entitlement across two or more providers please nominate the main setting where the local authority should pay the DAF and universal 15 hours funding.
Parent/Carer/Guardian with legal responsibility declaration
I am eligible for (Please refer to ‘Parents Notes’ on page 4 and tick)
- 15 hours for two year olds (see note 1)
- 30 hours for three and four year old (see note 2)
- 15 hours for three and four year old (see note 3)
- Disability Access Fund i.e. in receipt of DLA (see note 4)
- Early Years Pupil Premium (see note 5)
- I agree that the information given above is correct, and I give permission for Warrington Borough Council to check my eligibility status with the relevant benefit providers, and hold my details to make further checks related to the Early Years Pupil Premium and Disability Access
- I understand that if I knowingly or fraudulently claim more than the maximum for the term I will be liable for any loss incurred by the Government, Local Authority or Provider(s) named on page
|Parent/Carer/Guardian with legal responsibility||Childcare Provider|
|Print name||Print name|
The Data Protection Act 1998 puts in place certain safeguards regarding the use of personal data by organisations, including the Department for Education (DfE), local authorities and schools. The Act gives rights to those (known as data subjects) about whom data is held, such as pupils, their parents and teachers. This includes:
- The right to know the types of data being held;
- Why it is being held; and
- To whom it may be
Should you have any concerns in relation to how your information or the information relating to your Child/ren is being or will be used, please contact your provider or email the Early Education Funding team at EEFTeam@warrington.gov.uk.
Please note that information about whether a child is in receipt of Disability Living Allowance is sensitive personal data which should be handled appropriately. Providers are asked to pay particular note to advice from the ICO on holding personal data including sensitive personal data available at: https://ico.org.uk/for- organisations/guide-to-data-protection/principle-3-adequacy/
Note 1: To be eligible for 15 hours for my two-year-old I must be in receipt of one of the following:
- Income Support / Income Based JSA / Income related ESA
- Child Tax Credit (with or without Working Tax Credits) and combined taxable income of less than
- Universal Credit
- the Working Tax Credit 4-week run on (the payment you get when you stop qualifying for Working Tax Credit)
- The Guarantee element of State Pension Credit
- Support under Part VI of the Immigration and Asylum Act
- Child in receipt of DLA
- Child is Looked After, has left care through Adoption, Special Guardianship or Child Arrangement Order
- Child has current Statement of Educational Needs or an Education Health and Care
Note 2: To be eligible for 30 hours for my 3 or 4 year old I must earn less than £100,000 and meet one of the following criteria:
- Single parents who works at least 16 hours or earns more than £120 / £112.80*
- Couple – both parents work at least 16 hours/week or each earn more than £120 / £112.80*
- Working will include those on statutory sick pay, parental, adoption, maternity or paternity leave
- One parent is employed and the other parent is in receipt of specific carers’ benefits, or specific disability or incapacity
- These weekly amounts are based on working 16 hours at the National Living/Minimum Wage which is different for different ages e. at 25 years you need to earn at least £120 per week, for 21 to 24 year olds this will be at least £112.80 per week and a lower rate again for under 21’s.
Note 3: All 3 and 4 year olds are entitled to 15 hours early education. If you are not entitled under note 1 or note 2 you can choose to pay for additional hours yourself and you may get support from the Government through Tax/Universal Credit or through Tax Free Childcare.
Note 4: Early Years Pupil Premium (EYPP) is an additional sum of money paid to childcare providers for three and four year olds of families in receipt of certain benefits including
- Income Support / Income-based JSA / Income-related ESA
- Support under Part VI of the Immigration and Asylum Act 1999
- the guaranteed element of State Pension Credit
- Child Tax Credit (provided you’re not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190)
- Working Tax Credit run on – paid for 4 weeks after you stop qualifying for Working Tax Credit
- Universal Credit
- Child is Looked After, has left care through Adoption, Special Guardianship or Child Arrangement Order.
Note 5: 3 and 4 year old children who are in receipt of child DLA and are receiving the free entitlement are eligible for the Disability Access Fund (DAF). DAF is paid to the child’s setting as a fixed annual rate of £615. See – https://www.gov.uk/disability-living-allowance-children/overview
For more information please speak to your childcare provider or a member of the Early Education Funding Team on 01925 442983 or email EEFTeam@warrington.gov.uk.