Common use of Early Years Inclusion Funding Clause in Contracts

Early Years Inclusion Funding. I agree for my child’s details to be shared with the Local Authority for the purpose of an application for Early Years Inclusion Funding. Child’s name…. ………………………………………….. Date of Birth ………………….. Signature of Parent/Carer …………………………………………….. Date ……………………… Appendix F Free School Meal Criteria • Income Support • Income-based Jobseeker’s Allowance • Income-related Employment and Support Allowance • Support under Part VI of the Immigration and Asylum Act 1999 • The guaranteed element of Pension Credit • Child Tax Credit (provided you’re not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190) • Working Tax Credit run-on - paid for 4 weeks after you stop qualifying for Working Tax Credit • Universal Credit - if a parent is entitled to Universal Credit they must have an annual net earned income equivalent to and not exceeding £15,400, assessed on up to three of the parent’s most recent Universal Credit assessment periods. MULTI-AGENCY REFERRAL FORM FOR ALL CHILDREN, YOUNG PEOPLE AND FAMILY SERVICES New Referral Tel: 00000 000000 New Email: Send securely to: xxxxxxxxxxxxxx.xxxxxxxxx@xxxxxxxx.xx.xx Please send electronically in a Word Document Making a Referral: Any additional evidence can be attached to the form. If the reasons for referral include Child Exploitation please ensure the CE risk assessment tool has been completed and is attached. Also please complete and attach the Young Carers screening tool if the referral relates to Young Carers. Referrer Details: Completed by: Designation: Organisation: Address: Telephone No: Date: Email: Consent and Permission: Seeking consent is the responsibility of the referrer. Do you have consent to make this referral? Yes ☐ No ☐ If NO, please provide details here: Do you have permission to share information with agencies? Yes ☐ No ☐ If NO, please provide details here:

Early Years Inclusion Funding. I agree for my child’s details to be shared with the Local Authority for the purpose of an application for Early Years Inclusion Funding. Child’s name…. ………………………………………….. Date of Birth ………………….. Signature of Parent/Carer …………………………………………….. Date ……………………… Appendix F Free School Meal Criteria •  Income Support •  Income-based Jobseeker’s Allowance •  Income-related Employment and Support Allowance •  Support under Part VI of the Immigration and Asylum Act 1999 •  The guaranteed element of Pension Credit •  Child Tax Credit (provided you’re not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190) •  Working Tax Credit run-on - paid for 4 weeks after you stop qualifying for Working Tax Credit •  Universal Credit - if a parent is entitled to Universal Credit they must have an annual net earned income equivalent to and not exceeding £15,400, assessed on up to three of the parent’s most recent Universal Credit assessment periods. MULTI-AGENCY REFERRAL FORM FOR ALL CHILDREN, YOUNG PEOPLE AND FAMILY SERVICES New Referral Tel: 00000 000000 New Email: Send securely to: xxxxxxxxxxxxxx.xxxxxxxxx@xxxxxxxx.xx.xx Please send electronically in a Word Document Making a Referral: Any additional evidence can be attached to the form. If the reasons for referral include Child Exploitation please ensure the CE risk assessment tool has been completed and is attached. Also please complete and attach the Young Carers screening tool if the referral relates to Young Carers. Referrer Details: Completed by: Designation: Organisation: Address: Telephone No: Date: Email: Consent and Permission: Seeking consent is the responsibility of the referrer. Do you have consent to make this referral? Yes ☐ No ☐ If NO, please provide details here: Do you have permission to share information with agencies? Yes ☐ No ☐ If NO, please provide details here:

Early Years Inclusion Funding. I agree for my child’s details to be shared with the Local Authority for the purpose of an application for Early Years Inclusion Funding. Child’s name…. ………………………………………….. Date of Birth ………………….. Signature of Parent/Carer …………………………………………….. Date ……………………… Appendix F Free School Meal Criteria • Income Support • Income-based Jobseeker’s Allowance • Income-related Employment and Support Allowance • Support under Part VI of the Immigration and Asylum Act 1999 • The guaranteed element of Pension Credit • Child Tax Credit (provided you’re not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190) • Working Tax Credit run-on - paid for 4 weeks after you stop qualifying for Working Tax Credit • Universal Credit - if a parent is entitled to Universal Credit they must have an annual net earned income equivalent to and not exceeding £15,400, assessed on up to three of the parent’s most recent Universal Credit assessment periods. MULTI-AGENCY REFERRAL FORM FOR ALL CHILDREN, YOUNG PEOPLE AND FAMILY SERVICES New Referral Tel: 00000 000000 New Email: Send securely to: xxxxxxxxxxxxxx.xxxxxxxxx@xxxxxxxx.xx.xx xxxxxxxxxxxxxx.xxxxxxxxx@xxxxxxxxxxxxxxxxxxx.xx.xx Please send electronically in a Word Document Making a Referral: Any additional evidence can be attached to the form. If the reasons for referral include Child Exploitation please ensure the CE risk assessment tool has been completed and is attached. Also please complete and attach the Young Carers screening tool if the referral relates to Young Carers. Referrer Details: Completed by: Designation: Organisation: Address: Telephone No: Date: Email: Consent and Permission: Seeking consent is the responsibility of the referrer. Do you have consent to make this referral? Yes ☐ No ☐ If NO, please provide details here: Do you have permission to share information with agencies? Yes ☐ No ☐ If NO, please provide details here: