Childcare Change of Circumstances Form

This form should be completed if:-

Your childcare weekly rate changes or you become eligible for a Free Early Education & Childcare subsidy or any other external childcare funding.
Your college timetable changes.
You start a new course.
You require additional childcare due to sitting exams

Once you have completed this form, the college will contact your childcare provider for confirmation of the new weekly rate. When your application has been assessed, you and your childcare provider will receive notification of the outcome via email.

Your Personal Details

Student ID Number (if you know it)

Name*

Forename Surname

Date of Birth*

Home Address

Street Address Address Line 2 City ZIP / Postal Code

Contact Number*

Email*

Childcare Support Required

Start date of changes

Reason for Change

Child 1 Name*

Date of Birth

Childcare sessions required for the days you attend college:

Child 2 Name

Date of Birth

Start date of childcare

Childcare sessions required for the days you attend college:

Adding additional child

True

Child 3 Name

Date of Birth

Start date of childcare

Childcare sessions required for the days you attend college:

Childcare Provider Details

Chlildcare Provider Name*

Address*

Street Address Address Line 2 City ZIP / Postal Code

Contact Number*

Email Address*

Terms and Conditions

Please read the Childcare Subsidy Terms and Conditions carefully. If there are any points requiring clarification, please contact Student Services on 01772 225656.

Learner Declaration and Consent

If any of the information you have provided in support of this application is found to be inaccurate, or deliberately misleading, the situation will be dealt with under the Student Disciplinary Procedure and you will be required to repay any payments received.

I agree to the privacy terms and conditions and the college’s privacy policy.*

I confirm I have read and understood the Childcare Subsidy Terms and Conditions.*

I give consent for the college to contact my childcare provider as necessary.*