1
for Early Years Funding and Pupil Premium
Parent/Carer Declaration 2020/21
What is Early Years Funding? up to 570 hours of free early learning and childcare per year:
- 2 year old entitlement - Some two year olds are entitled if certain criteria is
met
- Universal entitlement - All three and four year olds are entitled; eligible date of birth is the only criterion
- Extended entitlement - Three and four year olds of working parents may be eligible if certain criteria is met
Before completing this form, please make sure you have read the Information for parents 2020-2021 Leaflet which
can be found on the county webpages. Go to cambridgeshire.gov.uk and search for ‘Early Years Funding’.
Applying for Early Years Funding
This form and proof of your child’s identity and age is a mandatory part of the process for claiming Early Years
Funding. Your early years provider will be able to support you in your claim and in completing this form.
Name of provider Ofsted URN No
1) Child details
Address and post code
Gender
Proof of identity (birth certificate, passport etc)
Legal Forename in full (no
nicknames or middle names)
Legal Surname
Name by which child is known if
different to above
Date of birth
Extended entitlement code 2+ Authorisation Code
Child’s ethnic group (please tick appropriate category from the choice below)
White British
WBR
White/Black Caribbean
MWBC
Indian
AIND
White Irish
WIRI
White/Black African
MWBA
Pakistani
APKN
Traveller of Irish Heritage
WIRT
White and Asian
MWAS
Bangladeshi
ABAN
Gypsy/Roma
WROM
Any other mixed background
MOTH
Any other Asian background
AOTH
Any other White background
WOTH
Black Caribbean
BCRB
Chinese
CHNE
Refuse to provide
REFU
Black African
BAFR
Any other background
OOTH
Info not obtained
NOBT
Any other Black background
BOTH
2) Siblings if your family has other children who are 0-5 years old living in the home please provide the name
and date of birth below.
3) Parent Details
The information in this section is needed to make eligibility or validation checks for extended entitlement, Early
Years Pupil Premium, and/or Disability Access Funding. Completing this section and signing this form gives us
permission to use your details to make these checks. Your personal information will be kept by your provider in
accordance with their Data Protection policies.
Extended Entitlement Checks are made against HMRC data throughout the year regarding your continued
eligibility. You must reconfirm your details to HMRC every three months to confirm eligibility. If your eligibility
lapses, only HMRC is able to reverse this decision.
Disability Access Funding (DAF) If your child is in receipt of Disability Living Allowance (DLA) please select Yes
below. Let your provider have a copy of the letter confirming the child’s entitlement to DLA in order to access DAF.
If your child is attending more than one provider, you will need to nominate only one setting where you wish the
DAF to go. Your provider will give you information about the DAF.
Yes / No Is your child in receipt of Disability Living Allowance?
If your child is eligible, who will be your Nominated
Provider?
Y/N
2
Early Years Pupil Premium (EYPP) Eligible children will be funded through the provider to support the learning
and development needs of the child. If you qualify on an economic basis, information must be the eligible
parent/carer’s details.
Economic Check details
Parent/Carer Details Applicant 1 Parent/Carer Details Applicant 2
Parent/carer’s title
Parent/carer’s full name
National Insurance or NASS No.
Parent/carer’s Date of Birth
Parent/carer’s telephone No.
Address including post code
(if different from child’s)
Other qualifying criteria for EYPP
Please tick and complete if you are able to let us know if the child meets one of these criteria. Your provider may
ask to see legal documentation so that they can obtain the funding for your child.
Currently in care, state which Local Authority
Previously in care in England or Wales
Has been adopted from care in England or Wales
Has left care under a special guardianship order or residence order in England or Wales
4) Setting and attendance details You will need to agree and complete a form with each setting your child
attends. Your child may attend multiple providers but no more than a maximum of two sites in a day. Please refer
to the table below to see the maximum hours that can be claimed in each funding period:
Non-stretched
Stretched
Spring
165 (11weeks x max 15hours)
148.2 hours (13 weeks x max 11.4 hours)
Summer
195 (13 weeks x max 15 hours)
239.4 hours (21 weeks x max 11.4 hours)
Autumn
210 (14 weeks x max 15 hours)
182.4 hours (16 weeks x max 11.4 hours)
Total
38 weeks @ 15 hours = 570 hours
50 weeks @ 11.4 hours = 570 hours
Please provide the number of hours you will claim as free hours for both universal and extended entitlement with
each childcare provision your child attends. You and your provider must note any changes you make to your
claim/s throughout the year using the Supplementary claim sheet if more space is needed.
2
nd
additional
provision
3
rd
additional
provision
Total hours (add
all provisions)
Autumn
Universal Hours
Extended Hours
Spring
Universal Hours
Extended Hours
Summer
Universal Hours
Extended Hours
2
nd
Additional provisionname of setting ................................................................................................
3
rd
Additional provisionname of setting ................................................................................................
3
5) Declaration
In si
gning this form I am confirming I have read the Information leaflet which gives details of the Early Years Funding
for parents/carers. I agree with the conditions of the Early Years Funding and Pupil Premium and the use of my
data. I understand that:
my provider is not obliged to end the claim without reasonable notification and negotiation unless there are
exceptional circumstances.
my free place may be withdrawn if my child does not attend regularly unless there are special circumstances and
these are agreed with the provider.
Data
Protection: We collect your details to process your application for Early Years Funding and to contact you
about related EY funding issues and tasks in accordance with The Early Years Funding Agreement.
In addition we can be required to share information with our partners, for example health organisations and
Children and Families Centres, to improve the wellbeing of children in Cambridgeshire area as required by the
Children Act 2004. Information shared between partner organisations is proportionate and only given when it is
necessary to help those partner organisation services with their legal obligations.
We are required to provide statistical data to the Department for Education. We also use statistical data for our
own internal research, statistical analysis or statistical surveys to help manage our service provision, and also
share data with academic institutions or independent researchers with a legitimate need for information for their
research.
All Early Years Funding application data is stored securely and maintained in accordance with the Data
Protection Act. Cambridgeshire online systems that are publicly available for entry of personal application data
are regularly independently tested to assess risk of penetration and to guard against unauthorised entry for
access to personal or any other data. This includes ensuring that the username and password access meets
industry standards.
Further information about how we collect and use data, and your rights around this, can be found on our
Privacy page on our website: www.cambridgeshire.gov.uk/privacy . Our Data Protection Officer can be contacted
via data.protection@cambridgeshire.gov.uk or 01223 699 137.
I conf
irm that the information is true to the best of my knowledge. I understand that any false or incorrect
information could lead to funding being withdrawn or reimbursed. Please be aware that to certify false information
could be viewed as making a false claim.
Sig
nature of Parent/carer with legal responsibility ___________________________________ Date _______
Name (
printed) _______________________________________ Relationship to child ___________________
For adm
in use only
Type
of identity seen for child
Checked by whom? Date seen
Legal Name of child as shown on document
Date of birth as shown on document
Notes
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