Application Form for New or Existing Provision in

Need of Financial Support

2017 - 2018

  1. Setting Name:
  1. Address:Correspondence Address

Postcode

Email address:

  1. Type of Setting– please tick all services you provide below

Playgroup □

Cylch Meithrin□

After School Club □

Day Nursery □

Registered Childminder□

Wraparound □

  1. Date when setting was/will be established:
  1. Ages of children catered for:
  1. Number of places available in the setting (please state how many places you are registered for):
  1. Number of children using the provision:
  1. Days open (Please ):

Monday TuesdayWednesday Thursday

FridaySaturdaySunday

  1. Times of opening:

MorningAfternoon

  1. Current average occupancy (i.e. what is the average number of children that attend each session):

13.a)For existing provision:

Provide occupancy trends over the last 12 months (give monthly figures if possible):

13.b)For new provision:

Provide details of your anticipated take up for the first 12 months of service.

  1. Fee structure: (please enclose your most recent fee structure or ensure it is available in your business plan)
  1. Please give details of your provision:
  1. Please state amount of grant required to ensure the future of the provision:
  1. Please give details of the circumstances that have created the need for this application.
  1. What would you use the grant for? (You must provide a detailed breakdown with costings – attach separate sheet if necessary)
  1. How will you ensure the long-term success of your setting and how do you intend to make the provision financially viable? AN ACTION PLAN/BUSINESS PLAN MUST BE SUBMITTED WITH THIS APPLICATION FORM(if you need support to develop an action plan please contact the Early Years and Childcare Unit)
  1. Are you receiving any other sources of funding?

No Yes

If Yes, please state:

Name of funder:______

Purpose of grant:______

  1. Are you a member of a professional childcare organisation?

If Yes, please name:______

If not,you will be required to affiliate to your relevant professional childcare organisation

For further details and contact details please ring 01639 873018

  1. Has your setting achieved a Quality Assurance award?

If yes, when______

If no, you will be required to register to undertake a Q.A. award within 12 months of receiving funding

Yes ______No______

  1. Please confirm that every member of staff/volunteer/student on site in your setting has an up to date DBS certificate:

Yes □ No □

If no please state reason: ______

  1. Are you registered with the Family Information Service and given permission for your service to be listed on ?

Yes □No □

If no, you will be required to complete a database form before funding will be allocated.

Signed: …………………………………..Date: ………………………….

Name: …………………………………..Position: ………………………

Please Return this Application Form to:

Grant Applications

Early Yearsand Childcare Unit

Ffrwdwyllt House,

Commercial Road,

Taibach,

PORT TALBOT

SA13 1PZ

You must enclose the following with your Grant Application:

a)Copy of last years Annual Accounts (if available)

b)Copy of last 3 months bank statements

c)Copy of Business Plan (please request a sample business plan if you need one)

For Office Use:

Date Application Received: ………………

Group Approval Date………………………

Grant Paid: ………………………………….

Monitoring Visit Date (if applicable)……………………………………..

Masters/grant application form