Early Years SEND Top-up Funding

Application Forms

(October 2016)

Early Years SEND Top-up Funding Criteria:

Category A: Cognitionand Learning

Category B: Communication and Interaction

Category C: Behaviour, Social and Emotional Development

Category D: Sensory

Category E: Medical and Physical

Please ensure that:

* you select a correct form for the category and level you are applying for.

* a correct form must be used for all New applications and Re-submissions.

* you refer to the Early Years SEND Top-up Funding Criteria booklet.

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Early Years SEND Top-up Funding Application Form: A0

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidencefor A0 (List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: A0 / Evidence
Children with moderate learning difficulties
(MLD)
  1. Child is developmentally delayed in more than one EYFS area of learning and there are concerns about the characteristics of learning.

  1. Support needed for up to 40% of time.

  1. Professional involvement from Health, Social Care and/or Education services has been sought.

  1. Has a recognised need for support with personal care and/or meal times.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: A1

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidence for A1(List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: A1 / Evidence
Children with severe learning difficulties (SLD)
  1. Child is two age bands below their chronological age on ‘Development Matters Best Fit’ profiles in 2 of the 3 prime areas.

  1. Learns at a much slower rate than peers across most areas of learning and development and so makes slow progress.

  1. Range of Health, Social care and Education professional involvement.

Requires specialist adult support to access the learning and social curriculum for a large part of the time. With this support the child can access a surface level of understanding but will still experience severe difficulties in making inferences and generalisation.
Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: A2

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidencefor A2 (List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: A2 / Evidence
Children with severe learning difficulties (SLD) plus extra difficulties
As the criteria for A0 and A1 and including:
  1. The identified additional needs should be considered as long term.

  1. Either medical, physical, sensory or behavioural difficulties associated with their learning difficulties.

  1. Child needs modification and explicit teaching of the curriculum for most of the timetable in order to facilitate their inclusion. This will involve detailed task analysis and teaching approaches such as prompting, explicit modelling etc. Such approaches will be required for social skills/responses, the learning of routines and personal development in addition to learning attainments.

  1. Ongoing intervention from Health and Education and possibly Social care.

  1. Child is 2 age bands below their chronological age on ‘Development Matters Best Fit’ profiles in all 3 prime areas.

  1. Child requires specialist adult support to access learning including social interaction for the majority of session time. With this level of support the child is able to access a surface level of understanding.

  1. The setting requires frequent (termly) specialist advice and input for staff oh how to enable full access to the curriculum.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: A3

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidence for A3(List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: A3 / Evidence
Children with profound and multiple learning difficulties (PMLD)
Children with profound and multiple learning difficulties have complex learning needs. In addition to very severe learning difficulties, children have other significant difficulties such as physical disabilities, sensory impairment or a severe medical condition. Children require a high level of adult support, both for their learning needs and also for their personal care and safety.
As the criteria A0, A1, A2 but child is also likely to have:
  1. Significantly delayed receptive and expressive language skills which may require Alternative and Augmented Communication.

  1. Vulnerability at mealtimes and during free play and delayed development of social skills leading to concerns over safety.

  1. Recognised need for support / supervision with personal care.

  1. Child requires specialist adult support to access learning including social interaction for 100% of session time.
Multi-disciplinary support from Education, Health and Social care.
Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: A4

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidence for A4(List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: A4 / Evidence
Severe learning difficulties (SLD) or profound and multiple learning difficulties (PMLD) with severe challenging behaviour
In exceptional circumstances, a child may be identified with a level of need over and above these criteria. In this very small number of cases, an allocation may be made on a time limited basis at a higher level.
Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: B0

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidence for B0(List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: B0 / Evidence
Children with speech and language impairment or communication difficulty/delay
  1. The child has either a speech and language impairment or communication difficulty/delay which is at least one age band below the chronological age of the child and may be due to social and emotional factors.

  1. On-going intervention/advice from Area SENCO Teamor Speech and Language Therapy Service is needed.

  1. Trained adult targeted on-going intervention is needed for 40% of the week to enable child to access learning including social interaction.

  1. The child has behaviour and/or emotional management needs associated with his/her communication difficulties and so requires intervention to support adult and peer relationships for part of the week. Some children at this level are compliant but have issues with anxiety whilst others may express their anxiety through non-compliant behaviours.

Setting INCCO Signature / Please Print INCCO Name / Date

Early Years SEND Top-up Funding Application Form: B1

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidencefor B1 (List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: B1 / Evidence
  1. The child is identified by a Speech and Language Therapist as having a specific speech and/or language disorder or a communication difficulty most likely to be a disorder.

  1. Trained / specialist adult on-going intervention is needed for a large part of the time attended, to enable child to access the areas of the curriculum: Language and Communication and Personal, Social and Emotional Development.

  1. Behaviour and/or emotional management needs are associated with communication difficulties and require intervention to support peer relationships for a large part of the time.

  1. Learning opportunities are presented through extensive differentiation including regular need for targeted activity preparation.

  1. Modification of language content for all activities, interpreted in to the child’s particular means of communication e.g. Makaton.

  1. It is likely that staff will need specific skilled training to meet the child’s communication needs.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: B2

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidence for B2(List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: B2 / Evidence
As for the criteria B1 and including:
  1. Child requires on-going intervention from North Somerset education service (VLS / Area SENCO).

  1. Child requires trained / specialist adult support to access learning through play for 100% of funded hours.

  1. Exhibits challenging behaviour that very often impacts on the safety of himself/herself or other children/staff.

  1. Has a severe limited ability to understand consequences and take responsibility for his/her actions with or without intent.

  1. Requires verbal communication to be supported by alternative communication for 100% of interaction.

  1. Trained / specialist adult on-going intervention is needed intended to enable child to access learning and social interaction with adults and peers.

  1. Access to a range of specialist resources.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: B3

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidencefor B3 (List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: B3 / Evidence
As for the criteria B1 and B2 and including:
In exceptional circumstances, there may be a child who has extreme communication difficulties and exhibits a higher level of need than is identified by above criteria, and therefore two adults may be needed to support him/her due to particularly challenging behaviour. Such a child
  1. Exhibits extremely challenging behaviour that regularly impacts on the safety of himself/herself.

  1. Exhibits extremely challenging behaviour that regularly impacts on the safety of other children/staff is often threatened and put at risk.

  1. Exhibits extremely challenging behaviour that may result in damage to environment.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: C0

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidence for C0(List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: C0 / Evidence
Children who exhibit challenging behaviour:
  1. Have had regular advice and intervention from the setting’s INCCO.

  1. Will often exhibit challenging behaviour even when a structured behaviour management plan is in place and is supported by a member of staff for 40% of the week to access learning. Intensity and duration may be lessened by targeted support but frequency remains significant at least once per session.

  1. Displays some oppositional defiant behaviour / aggressive outbursts / intensive emotional distress.

  1. Is very easily distracted and needs a tightly structured support to engage in play and remain on task.

  1. Finds it difficult to approach / relate to peers appropriately and will sometimes use physical and verbal intimidation and aggression towards peers / adults or withdraws from peers and finds it difficult to respond to offers of friendship.

  1. Regularly disrupts other children’s access to learning.

  1. Have little awareness of impact of behaviour on others.

  1. Professional involvement from pre-school services has been sought.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: C1

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidencefor C1 (List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: C1 / Evidence
Children who exhibit severe and challenging behaviour:
  1. Exhibit severe and challenging behaviour even when a structured behaviour management plan is in place and is supported by a trained/specialist adult for a large part of the session to access learning. Intensity and duration may be lessened by targeted support but frequency remains significant i.e. 2-3 times a session.

  1. Have had intervention advice from Area SENCO Team.

  1. Exhibit repeated oppositional defiant behaviour.

  1. Exhibit high frequency distractibility and needs a highly structured support programme and adult support to access learning and stay on task for short periods.

  1. Are unable to approach / relate to peers appropriately and will regularly use physical and verbal intimidation and aggression towards peers / adults or withdraws from peers and finds it very difficult to respond to offers of friendship.

  1. Have displayed difficulties for two terms or more.

  1. Regularly disrupts the learning of others.

  1. Have limited awareness of the needs of others.

  1. Has spasmodic awareness of the consequences of behaviour.

  1. Are high risk and lacks awareness of danger.

  1. Are known to a range of pre-school services e.g. Education, Health or Children’s Social Care.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form: C2

(October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidence for C2(List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: C2 / Evidence
Children who exhibit severe and challenging behaviour:
  1. Exhibits severe and challenging behaviour even when a structured and differentiated behaviour management programme is in place and is supported by a trained / specialist adult for 100% of the week to access learning. Intensity and duration may be lessened by targeted support but frequency is high.

  1. Is presenting as a significant health and safety risk due to threatening and violent behaviour to peers and adults.

  1. Is showing high levels of oppositional defiant behaviour and refuses to comply with appropriate and reasonable requests.

  1. Is extremely distractible and requires constant adult support and prompting to engage in and stay on tasks.

  1. Is unable engage/interact and play alongside peers resorting to physical/verbal aggression or relate positively.

  1. Requires on-going intervention from outside agencies on a multi-professional basis.

  1. Significantly disrupts the learning of others.

  1. Exhibits self-harming behaviours and appears to have a poor self-concept.

  1. Is impulsive and puts self and others at risk.

  1. Displays regular intense emotional distress.

  1. Needs an identified area to withdraw to if appropriate.

Setting INCCO Signature / Please Print INCCO Name / Date

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Early Years SEND Top-up Funding Application Form:

D0 – Hearing Impairment (October 2016)

For children in receipt of 2, 3, 4 year-old funded early education (FEE)
This form must be used for all New applications and Re-submissions.
Child’s full name / Date of birth
Name and address of setting
List of evidencefor D0 – Hearing Impairment (HI) (List evidence in alphabetical order and note a date of each piece of evidence)
Early Years SEND Top-up funding criteria for the category and level: D0 (HI) / Evidence
Children with a hearing impairment:
  1. Have a moderate hearing impairment.

  1. Have a moderate hearing loss in either ear as advised by the Hearing Support Service or auditory neuropathy spectrum disorder.

  1. Receive audiological and learning support by a teacher of the deaf.

  1. Have a gap in linguistic development particularly vocabulary and formation of sentences or phrases.

  1. Require adult support advised by support teacher for the deaf for 40% of session time.

Setting INCCO Signature / Please Print INCCO Name / Date

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