FORM: PAF SCHOOL APPENDIX D (Parent/Carer to complete)

Parent Authorisation Form - Appendix D- Early Years Pupil Premium (EYPP)

This form must be completed in addition to the basic Parent Authorisation Form.

Child’s Name / Child’s DOB

Your school nursery may be able to claim EYPP additional funding to support your child’s development and learning if you meet at leastone of the eligibility criteria. For details about the criteria please speak to your school nursery or go to

  1. PARENT/CARER DETAILS

Please provide your details below to enable the economic eligibility check for EYPP to be completed.

Parent/Carer 1 / Parent/Carer 2
Title (please select) / Mr Mrs Miss Dr Other / Mr Mrs Miss Dr Other
Legal Forename
Legal Surname
Gender (please select) / Male Female Not specified / Male Female Not specified
Relationship to Child
Parental Responsibility / Yes No / Yes No
National Insurance Number / National Asylum Support Service Number
Address
Postcode
  1. ELIGIBILITY CRITERIA

To be eligible for EYPP you must provide evidence that you meet the eligibility criteria. You must answer yes to at least one of the questions below to be eligible.

Is your joint family income £16,190 per year or less?(If yes, please check your eligibility online using the EYPP checker . If you are eligible, please record the reference number you get from the checker.) / Yes No
Reference number:
Is your child adopted from care?
(If yes, please provide evidence to the school that your child has been adopted.) / Yes No
Has your child been looked after by the Local Authority for 1 day or more?
(If yes, please provide evidence to the school that your child has been looked after.) / Yes No
Is your child subject to a Child Arrangement Order, Special Guardianship Order (SGO)or Residence Order?
(If yes, please provide evidence to the school that your child has an order in place.) / Yes No
  1. PARENT / CARER AUTHORISATION

You must agree to the following declarations before your school nursery can claim EYPP for your child. Please mark the box to show you agree.

I understand that the information I have provided can be shared with the Local Authority and The Department for Education, who will access information from other government departments to confirm my child’s eligibility and enable this school nursery to claim Early Years Pupil Premium on behalf of my child. / Yes, I agree
I agree that if I would like to withdraw my consent for checking EYPP eligibility I should contact my school nursery. / Yes, I agree