Supplementary Information Form for Admission to Reach Nursery in September 2015

Please complete this form in addition to the London Borough of Hounslow’s Nursery place application form which is available on the school website or from the school office.

Parents/carers should complete this form if they wish their child’s application to be considered under the school’s “Pupil Premium” admissions criteria. Please return to the school office by the 1st May.

Up to 27% of places (16 out of 60 places) will be allocated to pupils eligible for the pupil premium at the time of application. If we receive applications that meet this criteria from more than 27% of places available, then places will be allocated in line with the over-subscription criteria set out in our admissions policy.

To be eligible for the Pupil Premium you must either be receiving one of the following:

  • Income Support;
  • Income based Job Seeker’s Allowance;
  • Employment &Support Allowance (must be Income Related and not Contribution Based); or
  • Child Tax Credit with no Working Tax Credit and where household income is less than £16,190.

Please complete the form overleaf and bring it to the School Office by the date set out above, along with evidence of being eligible for one of the above.

All parents must also complete the London Borough of Hounslow Nursery Place Application Form.

Completing this form does not on its own constitute an application to Reach Academy Feltham Nursery.

Child’s Forename / Child’s Surname / Child’s Date of Birth
_ _ / _ _ / _ _ _ _
Name of Parent/Guardian/Carer (who is in receipt of the qualifying benefit)
Address of Parent/Guardian/Carer
Postcode
National Insurance Number of Parent/Guardian/Carer (who is in receipt of the qualifying benefit) (Mandatory Field)
______
Date of Birth of Parent/Guardian/Carer (who is in receipt of the qualifying benefit)
_ _ / _ _ / _ _ _ _
Child’s UPN (Unique Pupil Number):
______
This number can be obtained from the school and should be included by parents of prospective Year 7 pupils where the child is not currently eligible for Free School Meals but has been within the last six years and is therefore in receipt of Pupil Premium funding in their current school.
Telephone Number / Mobile Telephone Number
Email Address / Current School
I certify that all information given on this form is true to the best of my knowledge and belief.
Signed ______Date______

Reflect – Endeavour – Aspire – Show Courage – Have Fun

Reach Academy Ltd is a charitable company limited by guarantee and registered in England and Wales. Company No: 7634106. Registered address: Bridge House, Hanworth Road, Feltham, Middlesex.TW13 5AB