2013 DCYA Ref no:______

(e.g. 09WX0350)

ECCE – RE-ENTRY

Application form for services re-entering the Early Childhood Care and Education (ECCE) programme from September 2013

(Please complete this form in BLOCK CAPITALS)

1 / For Private Services - Name and Home Address of Owner
2 / Owner’s Telephone Number / Landline -
Mobile -
3 / For Community Services – Name and contact telephone number of the Chairperson of the Board / Name –
Landline -
Mobile -
4 / For all services – Address for Correspondence
5 / Name of Manager
6 / Name and Address of Pre-School Service
7 / Telephone Number of Pre-School Service / Landline -
Mobile -
Fax -
8 / E-mail Address to be used for correspondence relating to the ECCE programme
Please tick the appropriate boxes relating to the following statements: / Tick Here
9 / I declare that I will have a minimum of 5 children of pre-school age (2½ to 6 years) in my service in September 2013, enabling me to deliver an appropriate ECCE programme.
10a / The staff members delivering the pre-school year are those previously advised to the Department, and their qualifications meet the requirements of the programme. (All Pre-School Leaders must hold a minimum qualification of a full FETAC Level 5 award.) OR
10b / I am attaching copies of the relevant qualifications held by the staff members who will deliver the Pre-School year from September 2013
11 / Are you applying/re-applying for Higher Capitation? If you are please attach ECCE Form 10.
12 / A current Tax Clearance Certificate (TCC) has been submitted to the Department.
(PLEASE NOTE it is YOUR responsibility to ensure that a current TCC has been provided to the Department. If you are not in a position to provide a current TCC by August 2013, you will NOT be permitted to participate in the programme during the pre-school year 2013/2014.)
13a / The details of the bank account to which ECCE funding should be transferred are as previously advised to the Department OR
13b / I am attaching a completed Electronic Funds Transfer (EFT 9) to notify a change of bank account

______

Signature of Owner / Chairperson Date

PLEASE COMPLETE THIS FORM AND

RETURN IT TO YOUR LOCAL CITY/COUNTY CHILDCARE COMMITTEE BY 29th MARCH 2013