To Be Completed by the Parent/Carer/Guardian with Legal Responsibility

Disability Access Fund Application Form

To be completed by the parent/carer/guardian with legal responsibility

Please note: Three and four year old children who are in receipt of child Disability Living Allowance (DLA) and are receiving the free nursery funding 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. This application will ensure payment is made to the child’s setting in order that they can use the funds to support access and inclusion within their setting.

The following child is in receipt of Disability Living Allowance:

Setting attended:

If your child is splitting their free entitlement across two or more providers please nominate the preferredsetting where you are asking the local authority to pay the DAF:

Declaration

The information supplied on this form will be used so that Cornwall Council can assess a child’s entitlement to receive Nursery Education Funding (funded early learning). We may also share this information with relevant partners including the Family Information Service, Children’s Centres, NHS, relevantChildcare providers for the applicant, Special Educational Needs & Provision team and/or the Council’s Disability Service. Anonymised information may also be shared to measure performance and to evaluate geographical spread of need. Your information will be held securely on password protected networks. Information will be held for 5 years after completion of the funded sessions and will then be disposed of securely in line with the Councils Destruction Policy. You declare that the information you have provided is accurate and true and understand that the funding is a one-off lump sum payment and is not transferable if your child moves to a different childcare provider part way through the financial year. A copy of the Council’s Data Protection Act Policy can be found at www.cornwall.gov.uk

Contact us on 01208 265688

Disability Access Fund

This is a new entitlement which can be claimed from April 2017. Three and four year old children who are in receipt of child Disability Living Allowance (DLA) and are receiving the free nursery funding entitlement are eligible for the Disability Access Fund (DAF) payment. DAF is paid to the child’s early years setting as a fixed annual rate of £615 per eligible child.

The payment is only made once in any 12 month period. If the child is attending more than one setting then the parent will decide which setting receives the payment as this can’t be split between settings and the payment is not re-claimed even if the child leaves.

This application form needs to be completed and signed by the parent to give authorisation for the setting to receive the payment. This needs to be returned to the nursery funding team with a copy of the child’s most recent DLA confirmation letter. Once all checks have been carried out the payment will then be made to the setting.

If any parent feels that they should be entitled to DLA for their child but are unsure how to make this claim Citizens Advice Cornwall provides free and confidential advice. One to one appointments are available at Children’s Centres across Cornwall offering adviceregarding debt, benefits and work. Appointments can be made by calling the local Children’s Centresfor more information. The ‘What’s on Guides’ for Children’s Centres across Cornwall can be accessed on the FIS website, which gives specific times, dates and contact numbers for your local area.

If you are unsure if the child has received their entitlement or for any other questions please do not hesitate to contact the nursery funding team on 01208-265688.