Early Years Pupil Premium Application Form

If you or your child meets any of the following criteria then as a school we may be entitled to claim extra funding to support your child’s learning and development. The information you provide will be handled confidentially and will only be used to check your eligibility.

Income Support
Income-based Jobseekers Allowance
Working Tax Credit run-on
Income related Employment and Support Allowance
The guarantee element of State Pension Credit
Support from NASS (National Asylum Support Service) under part 6 of the Immigration and Asylum Act 1999
Child Tax Credit (with no Working Tax Credit) with an annual income of no more than £16190

Details of Person Who Claims the Above Benefits (Parent/Guardian 1)

Details of Person Who Claims the Above Benefits (Parent/Guardian 2)


I certify that the information given on this form is correct to the best of my knowledge and belief. I understand that the council will check with the Department for Work and Pensions (DWP) and/or Her Majesty’s Revenues and Customs regarding my eligibility. We may need to use this information for enquiries under the Section 29.3 of the Data Protection Act – amended 1998 – Detection and Prevention of a crime. The information provided will also be used to target other early intervention support. I certify this information can be used by my local Children’s Centre.

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