Is your family eligible for a free early education place for a 2 year old?
Please complete the form to see if you meet the criteria. All questions must be answered
Are you receiving one of the following:
* Required
I am receiving universal credit and my household income is less than £15,400 a year
I am receiving Income Support
I am receiving Income-based Jobseeker's Allowance
I am receiving Income-related Employment and Support Allowance
I am receiving Working Tax Credit / Child Tax Credit (with an income below £16,190)
I am receiving support under Part VI of the Immigration and Asylum Act 1999
I am receiving the Guaranteed Element of State Pension Credit
I am not receiving any of the benefits listed above
Does your child get Disability Living allowance
Is your child adopted or looked after by Local Authority
If any of the last five options above apply to you:Please call Walsall Families Information service for more information on your application on: 01922 653383
Do you have a National Insurance Number?
* Required
None
Yes
No
Do you have a National Asylum Seekers Support Number?
* Required
None
Yes
No
Is your child 2 years old, or going to be 2 in the next 3 months?
* Required
None
Yes
No
Your Details
Your Surname/Family Name
* Required
Your First Name
* Required
Gender
* Required
None
Male
Female
Date Of Birth
* RequiredDate
Europe/London
Relationship to Child
* Required
National Insurance Number
* Required
Details of your 2 year old
Child's Surname/Family Name
* Required
Child's First Name
* Required
Gender
* Required
None
Male
Female
Date Of Birth
* RequiredDate
Europe/London
Do you have another child that you think is eligible for a free two year old place?
* Required
None
Yes
No
Contact Details
Address
* Required
Daytime Telephone Number
* Required
Email
* Required
Do you have a partner living at the same address?
* Required
None
Yes
No
Agreement
I allow Walsall Council to assess my child's claim via a secure computer link with the Department for Education. I agree that Walsall Council can use the information I have provided to process my claim for a free childcare place and can contact other sources as allowed by law to verify my initial and continuing entitlement. I confirm that as far as I know the information I have given is correct
Please tick to confirm that you have read, understood and agree to the above statement
* Required
Please tick to confirm that you have read, understood and agree to the above statement
I would like details of eligible childcare settings that offer the free 2 year old places
I would like details of eligible childcare settings that offer the free 2 year old places
Data protection
The Information you provide will be held in line with the Data Protection Act 1998. It will be held confidentially and we will not pass it onto 3rd parties, unless we are legally required to do so (i.e. in cases of child protection) We will keep it on our database to process this and any future enquiries and may contact you from time to time with information you may find useful or to get feedback.
Please tick to confirm that you have read, understood and agree to the above statement
* Required
Please tick to confirm that you have read, understood and agree to the above statement
Would you like to hear from your local Family Hub about the activities and support that they can offer you and your family?
None
Yes
No
How did you hear about Free Childcare for 2 year olds?
None
I received a letter
I received an email
I received a text message
From my Family Hub
From somebody working with my family
From a Childcare Provider
Word of mouth
Walsall Family Hub website
Facebook
Other
If other please specify
If you are happy that all your details are correct, please submit your claim. We will contact you in the next 5 working days to inform you of the outcome.
