Services for Young Children

Childcare Inclusion Funding (ChIF) application & grant monitoring form

(Revised September 2013)

To support high quality inclusion within the private, voluntary and non-maintained sector

Name of SettingPostcode

Type of provision please circleChildminderOut of School Pre school playgroup/day nursery

Area/District please circle Test ValleyEastleigh/Winchester New Forest East Hants

Basingstoke/Deane Fareham/Gosport Havant Hart & Rushmoor

Claim Dates - from……/………/…….to ……/……/ ……

Data Protection

The information you have supplied in this form will be used to process your grant application and for monitoring and statistical analysis purposes. Some of the information will be held on a database at Hampshire County Council.

Contact details for your organisation

1. Name of your organisation

2. Ofsted URN

3. Address of your organisation

Postcode:

4. Website address of your organisation (leave blank if not applicable)

The main contact person for this application

5. TitleFirstnameSurname

6. Position in your organisation (For example, ‘Treasurer’ or ‘Secretary’.)

7. Contact address (if different from above)

Postcode:

8. Contact details:

Daytime Mobile SfYC Businesse-mail address (this must be filled in)

Information about your organisation

9. How would you describe your organisation? (Please tick all boxes that apply)

Early Years setting Day nursery Out of school setting Childminder 

Extended services (voluntary register) Registered charity

Registration No. ______

Voluntary organisation Community Group

Company limited by guarantee Social Enterprise

Not-for-profit organisation School/college Other Please describe:

Support for your setting?

Area Inclusion Coordinator (Area InCo)

Name ______

e-mail address ______

and / or

Children’s Links Development Officer

Name ______

e-mail address ______

and / or

PACEY Network Co-ordinator

Name ______

e-mail address ______

and / or

Specialist Teacher Advisor

Name______

e-mail address ______

and / or

Portage home visitor

Name______

e-mail address______

Attendees / Contributors to Planning Meeting
Date of meeting: ______
Name / Job title / position / Signature

Please ensure that the form is received by your Area Inclusion Coordinator no later then 3 weeks after the planning meeting. Failure to do so may impact on our ability to award a grant.

Section 1 : The Inclusion Plan
(a) Give examples of good quality childcare that is currently provided for all children and young people at your setting
e.g.: Self-reflective practice, continuous professional development (CPD), looking at ‘strengths’ and ‘can do’s’
(b) Please explain how you will ensure that the childcare provided will meet the needs of all children and young people, what strategies might you use?
e.g: provide visual timetable or ‘offer smaller group opportunities’ instead
(c) What resources might you require?
e.g.: a set of Makaton symbols, additional staffing etc.
(d) What staffing approaches might be necessary?
e.g.: training, key person approach, offer smaller group activities
(e) What do you hope the aims and outcomes of your inclusion plan will be?
e.g.: children or young people will require less staff support, smoother transition and improved accessibility
Section 2: Planned expenditure (if required)
For all grants please complete each of the columns showing the details of the project expenditure (continue on a separate sheet if required).
Expenditure / Details(staff hours, resource details, training costs) / Costs applied for
Additional staff costs (£4.50 per hour)
Other staff costs
Specialist input
Resource costs - please give details of equipment to be purchased
(or requested from the SEN Resource Units)
Training costs (please list)
Expenditure total

Other funding received e.g. grants

Please give details (including amounts) of grants you have already received or intend to apply for from other organisations/bodies within this current financial year.

Organisation/awarding body / Purpose / Date of award / Amount awarded £
Section 3: Action Plan
This section displays the actions to be completed within the grant period, agreed at the planning meeting, and will be used at the review meeting to look at the development of good inclusive practice.
Action / By whom? / By when?
ChIF Review meeting to be arranged before the end of grant period
Section 4: Conditions for grant payment
This section to be completed by the Area Inclusion Coordinator, NCMA Network Coordinator. It must include all conditions (if any) to be placed on this or future applications, for example attendance at particular training or review of policies and procedures.
1. / Early years settings will regularly attend their Senco Support Group
2. / Childminder applicants will contact theirNetwork Co-ordinator (PACEY’) prior to applying
3.
4.
5.
6.
8
Section 5: Services for Young Children Monitoring
Please indicate below whether any of the children or young people attending your setting:
No.of children
Receive DLA (disability living allowance) Higher Rate and/or attend special school
Have a statement of Special Educational Needs (SEN)
Are Children in Care (CiC)?
Meet SEN Funding criteria (include Under 3’s, joint specialist placements etc)
Common Assessment Framework (CAF) or Early Support in place
Number of children referred through the SPACE (community childminding scheme)
Number of children receiving Short Breaks funding
If there are no children identified above please give reasons or circumstances for this claim below
Application declaration
I declare that I have completed all relevant sections of the application accurately, and that this organisation has the power to accept a grant under the grant conditions.
NB: The signatory must be a member of the provision’s management committee or the owner
Signed: ______/ Position: ______
Name: ______/ Date: ______
This information will be held in accordance with the Data Protection Act 1998 for the purposes of assessing and monitoring grant applications for a maximum of five years.
Services for Young Children endorsement:
Approved by (Area Inco):
Signed:______Name______Date__/__/__
Approved by (Inclusion Team Leader ):
Signed:______Name______Date__/__/__

Please ensure that your Area Inclusion Coordinator receives this form for endorsing no later than 3 weeks following the planning meeting.

It is strongly recommended that you retain a copy of this form for your records

Contact details for Inclusion Team Leaders and PACEY organisation

Hampshire Area / Address and telephone
Basingstoke & Deane
/ Services for Young Children
Vertex Building
Chineham Court
Lutyens Close
Basingstoke
RG24 8AG
Tel: 01256 395095
Hart & Rushmoor
East Hants / Services for Young Children
2nd Floor, Rushmoor Borough Council Offices
Farnborough Rd
Farnborough
Hampshire
GU14 7JU
Tel: 01252 814770
Havant / Services for Young Children
Mill Hill Early Years Centre
Mill Road
Waterlooville
PO7 7DB
Tel: 02392 259906
New Forest / Services for Young Children
CalmoreInfant School
Calmore Drive
Southampton
SO40 2ZZ
Tel: 02380 667360
Eastleigh & Winchester
TestValley / Services for Young Children
The Aviary Children’s Centre
Blackbird Road
Nightingale Avenue
Eastleigh
SO50 9JW
Tel: 02380 650034
Fareham & Gosport / Services for Young Children
Woodcot Primary School
Tukes Avenue
Gosport
Hants
PO13 0SG
Tel: 01329 286750
PACEY
Hampshire / PACEY
Telford House (2nd Floor)
Hamilton Close
Basingstoke
RG21 6YT
Tel: 01256 300722

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