Inclusion Funding for Education and Care – Form 2

Use this form if an Early Years Initial Assessment has been undertaken in the last 6 months.

If not, the Early Inclusion Funding for Education and Care – Form 1 should be completed.
Please complete details below according the level of funding being applied for:
Name of child: DOB:
Please note, if applying for Exceptional Needs SEND Funding or CARE Funding a Supporting Statement from The Early Years Support Team or an Early Years SEND Advisory Teacher must be attached to this request.
Please tick the relevant box/boxes.
SEND Funding
Stage 2 SEND Funding
(1 hour per session or maximum of up to 5 hours per week 1:1 support) /
Exceptional Needs SEND Funding
(Maximum of up to 15 hours per week full time 1:1 support)
/
CARE Funding
Number of hours per week applied for:
Name of Setting:
Address (for correspondence):
Telephone Number:
/ Email address:
Contact Name:
/
Position:

Ethnic Origin: ………………………………………………………………………………………………..

Language spoken in the home: ………………………………………………………………………….

Is the child looked after by the Local Authority? Yes o No o

When did the child begin attending your setting: ……………………………………………………

The term the funding is being applied for: …………………………………………………………….

Number of half day SESSIONS PER WEEK the child will be attending: ……

Hours per session (mornings) ……. (afternoons) ……….

What arrangements will be made to support the child with the funding? (e.g. will the adult

work individually or in a group, when and how etc.) ………………….……………………………..

………………………………………………………………………………………………………………….

Parent / Carer Views:
Please complete this section wherever possible

I am aware of the contents of this form and have seen the supporting evidence.

SIGNED………………………………………. Parent / Carer DATE ……………………

Please ensure that this application form is signed by the Pre-school practitioner and the child’s parent / carer and that you have included the following information:

Please tick to confirm enclosed:

Initial Assessment ٱ

Copy of reviewed and new outcomes on the SEND Support Plan ٱ

Any other relevant supporting evidence ٱ

Names and reports of other professionals involved ٱ

Exceptional Needs Funding for Education and Care requests -

Supporting Statement from Early Years Professional attached ٱ

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

Designation: ……………………………………………………………………………………………

Please print name: ……………………………………………………………………………………..

Date: ………………………………………………………………………………………………………

On completion please return form to:

Sue Briggs

Business Support Officer

Central Bedfordshire Council

Children’s Services, School Improvement

Watling House, High Street North

Dunstable

Beds LU6 1LF

Request for Early Years Inclusion Funding for Education and Care - Form 2 – March 2017