Access to Education Grant request
This grant is for children receiving free Early Years education, who have complex Special Educational Needs or disabilities.
Name of the child………………………………………………………Date of Birth………………………………..
Name of the Early Years Setting making request……………………………………………………………………
Date of Request…………………………..Early Help involvement yes /no
Lead professional…………………………....
Name/s of any other Early Years Settings that the child attends ………………………………………………………………
(This setting may be contacted for further information)
SIGNATURE OF PARENT………………………………………………………………..(The panel will not consider unsigned requests)
Supporting Evidence
Does the child have a recognised/diagnosed disability?YES/NO
If yes then please state details:……………………………………......
…………………………………………………………………………………………………………..
…………………………………………………………………………………………………………..
Please comment on any of the following areas relevant to this child. Make specific reference to professional advice provided.
Mobility (attach additional sheets if necessary)
Staying safe (attach additional sheets if necessary)
Communication (attach additional sheets if necessary)
Care/medication (attach additional sheets if necessary)
Reports may be attached with the permission of parents and the professional providing the advice. Gaining permission for sharing reports is the responsibility of the setting.
Number of hours child attends setting each week:……………………………………………… Does this include the 30 hours extended entitlement? YES / NO
How much funding is requested?………………………………………………
What period will this funding cover?………………………………………………
Please provide a summary of any supporting evidence submitted as part of this application. For example: Shropshire's early language development chart; Learning plans; Early years outcomes (Individual Tracker); Professional advice; Portage; Speech and language therapists; Physio; Health Visitor.
How will funding be spent?
Please provide specific details of any resources which will be purchased and how these will be used to support the child
PROVISION MAPName ……………………………………………….. D.O.B…………………………………... Date of intervention …………… Review Date ......
Key person…………………………………………. SENCO………………………………… Date of request for funding ………......
Provision to meet outcomes / MondayAm Pm / Tuesday
Am Pm / Wednesday
Am Pm / Thursday
Am Pm / Friday
Am Pm / TOTAL
One off costs / purchases specific to child / Cost
Please use this space to add any additional information to support this request:
Setting manager (signature)Setting SENCO (signature)
Contact nametelephone number secure email
Speech chart / Learning plans / Professional advice / Portage / SALT / Physio / Health Visitor / Other