Early Start and Family Services – People Directorate

Early Years Inclusion Grant Application 2018-2019

The Early Years Inclusion Grant is for early year’s providers to help them support the needs of individual children with lower level or emerging SEN.Please read the guidance document before filling in this application form

Section 1
Setting Details
Setting Name / Date started on roll
Address
Telephone No
Email Address
Contact person at setting
Parent\s\Carers Name and Address
Are bothparents\carers working? (one in the case of a single parent) / Yes\No If working how many hours does each work
Section 2
Child’s Details:
Child’s Name
Date of Birth / Age (include months)
SEN support plan in placedate started (attach copy) / Number of cycles of review of SEN plan
Is there an Education, Health Care Plan in place (EHCP)? / Yes\No / If so please state the level:
Is there a care plan in place? / Yes\No / Is it signed by a Health Professional / Yes\No
Has specialist training been provided? / Yes\No / Is there a Fire Evacuation Plan in place? / Yes\No
Is there an Early Help Assessment (EHA) in place? / Yes\No / If yes please provide the EHA number
If an EHA is not in place please explain why one is not needed
Section 3
Details of child’s additional needs including any diagnosis and any barriers
Diagnosis:
Section 4
Areas of Learning and Development / Child’s expected level of develop-ment
(for age) / Child’s observed level of development
Developing, Secure, High
(D.S.H) / Comments
Prime Area -Personal, Socialand EmotionalDevelopment
Making Relationships
Self confidence
Managing feelings
and behaviour
Prime Area –Physical
Development Moving and Handling
Health and Self-care
Prime Area - Communication and Language
Listening and attention
Understanding
Speaking
Section 5
Applying for resources
Please give details of the specialist resources/equipment required (items over £2,500 will be considered but will require 3 quotes)
Section 6
How will the grant be used and what impact do expect it to how on outcomes for the child
Please explain how the grant will impact on the child’s development
Section 7
Applying for Additional Staffing
Funding Periods / Summer13 weeks + holidays
(9th April – 20th July 2018)
Autumn 13 weeks + holidays
(3rd September – 21st December 2018)
Spring 12 weeks + holiday
(7th January – 29th March 2019)
Please indicate which period you are applying for / Period:
(If funding is agreed it will start from the Monday after the panel meet)
End date:
If the child is accessing a stretched offer the weeks may extend into holiday periods
Levels of Funding
A contribution towards staffing costs will be paid at £6.05 per hour
Term time hours
In column 2 indicate hours attending EEF\TYEIn column 3 indicate how many EEF\TYE hours you are requesting funding for In column 4 indicate any wraparound hoursand In column 5 indicate wraparound hours requesting funding for
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Days of the Week / 2
EEF\TYE number of hours attending / 3
EEF\TYEnumber of hr’s requesting
grant for / 4
Wrap Around number of hours child attends / 5
Wrap Around
Number of hr’s requesting grant for
Monday
Tuesday
Wednesday
Thursday
Friday
Total
Is the child on a stretched offer? Yes\No
Hours attended per week / Total hours requested / Number of weeks / Total
Holiday
Section 8
Discussion with professional working with the setting e.g. Social Communication and Interaction (SCI), Early Years Area SENCo, Educational Psychologist (EP), Hearing/Vision Support Service
Name of professional: / Role: / Date of discussion:
Advice given and action taken from that discussion
Section 9
Setting Declaration
By returning this form (via secure email -Sophos) we agree to abide by the terms and conditions of this Grant.
We the undersigned declare to the best of our knowledge that the information provided in thisapplication is accurate and that the children identified have an up to date Early Years Support Plan/ medical care plan that is reviewed regularly (every six weeks) and have evidence of outside agency involvement.
We confirm that we have attached the parental\carer consent form which has been completed by the person\s with parental responsibility for the child named in this application.
We confirm that the owner\Directors\Governors\Management Committee\Trustees approve of this application.
Further information may be requested by BMBC for the purpose of audit. Failure to provide this evidence will result in the funding being re-claimed.
Date Submitted
(NB settings cannot apply retrospectively and must remember to re-apply if they wish the funding to continue the following period)
Please fill this form in electronically deleting yes/no where appropriate and return the application formby email to:: / using the Sophos secure system.

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Version 525/05/2018