Application for Enhanced Funding Individual

Transcription

1 Application for Enhanced Funding Individual How to Complete this Application Please carefully read the following information before completing your application. When completing your application: Print clearly. Funding Approval Process: The Community Program Coordinator reviews all applications, ensures eligibility criteria are met, registers all new applicants on the Wait List, and presents applications to the Review Sub-Committee. Complete all sections of the application. Failure to do so may result in a delay in the application process. The Review Sub-Committee meets a minimum of two times per year to review applications and to make funding recommendations. Attach a letter of employment or education schedule for each parent/guardian that verifies the days and hours of the approved activity. Ensure the application is signed by the parent/guardian, Child Care Program Supervisor, and applicable consultant, i.e. Early Interventionist. (see Section F of application) You can submit your completed application by mail, fax, or in person: Marina Dichiara, Child Care Services Co-ordinator Child Care Services, Social Services Branch Community and Health Services Department Unit Yonge Street Newmarket, ON L3Y 8W5 Phone: (905) , Ext or Toll-free at , Ext Fax: or marina.dichara@york.ca If you require additional information please contact South Community Program Co-ordinator, Jan Saville at Ext or jan.saville@york.ca, or contact North Community Program Co-ordinator, Darlene Preuten at Ext or darlene.preuten@york.ca Note: First time applications may be submitted at any time. All funding requests approved by York Region are for a maximum of six months. Funding periods are January to June and July to December. If required, you must re-submit an application to get further funding. Re-application deadline dates are the last week of April and the last week of October. Funding approvals are managed within the approved annual budget. When funding is at capacity, applications are entered on the wait list. The wait list is managed on a first-comefirst-served basis. As funding becomes available, applications on the wait list are addressed, as approved by York Region. Application Checklist Before you submit your application, make sure you have: completed all sections of the form obtained the required three signatures in Section F of the application attached the required letter of employment or education schedule for each parent/guardian If you do not complete all sections or are missing signature(s), your application may be considered incomplete and will not be processed until the information has been received. Community and Health Services Department Social Services Branch

2 Is this the first time you have applied for Enhanced Funding for this child? Yes (New Application) No (Re-Application) Section A Child Care Setting Information Program/Setting Name: Address: City/Town: Postal Code: Mailing Address (if different from above): City/Town: Postal Code: Phone: Fax: Supervisor/Contact Person: Supporting Agency Contact Person: (i.e. Early Intervention Services, Children s Mental Health) Resource Teacher On-Site: Yes No Program Type: Centre-Based Home-Based Section B Individual Child Information Child s First Name Last Name Date of Birth Day Month Year Confirmed Diagnosis Date Enrolled at Child Care Program Day Month Year Age group/classroom that children are enrolled in: Infant Toddler Preschool School Age Kindergarten Does child attend a School Board JK/SK program? Yes No Total number of children in age group/classroom: Number of staff assigned to group: Indicate Child s Attendance Schedule at Child Care Days Monday Tuesday Wednesday Thursday Friday Alt. Friday Hours (I.e. 9am to 3pm). Specify Presenting Areas of Need Safety Mobility Health Community and Health Services Department Social Services Branch

3 Section C Plan/Strategies for Safety Document the strategies to be used and the training plan to address the behaviours related to safety issues. What is the Issue/Need? (specify behaviour that results in a safety issue) bites other children/staff runs out of classroom & playground What Strategies are you Currently Using? redirection provide sensory integration/fidget kit close doors and gates visual supports (STOP signs) What is the Plan of Action? Autism training for staff rotate staff in room for 1 to 1 support during transitions During What Specific Times or Routines is Support Required? free play time 9 to 10 a.m. play time outdoor time Community and Health Services Department Social Services Branch

4 Section C Plan/Strategies for Mobility Document the strategies to be used and the training plan to address the special need(s) related to mobility issues. What is the Special Need? (that results in a mobility issue) What Strategies are you Currently Using? What is the Plan of Action? During What Specific Times or Routines is Support Required? child is immobile; other children walk over child child has visual impairment; a lot of stairs in program child is positioned in a safe area of the room closely monitored child s hand is held when using the stairs research strategies, assisted devices, etc. that will support the child with table tasks and floor activities rotate staff to implement and practice stair climbing exercise free play time transitions Community and Health Services Department Social Services Branch

5 Section C Plan/Strategies for Health Document the strategies to be used and the training plan to address the special need(s) related to health issues. What is the Special Need? (that results in a health issue) What Strategies are you Currently Using? What is the Plan of Action? During What Specific Times or Routines is Support Required? choking at mealtimes child has seizures child sits beside teacher encouraged to take small bites of food monitor and observe; implement seizure management techniques encouraged to eat a little bit at a time OT consultation First Aid training for Enhanced Funding Worker/all staff meal and snack times ongoing Community and Health Services Department Social Services Branch

6 Section D Community Supports 1. Document all support services currently involved with the children. Agency Name Contact Person Phone Number Dates of Involvement 2. List past and future training opportunities for staff to support inclusive practices. Type of Training Date of Training Number of Staff Involved 3. Existing supports and resources MUST already have been investigated prior to applying for funds. List all of your contacts/attempts. Agency Name Contact Person Phone Number Dates of Contact Section E Enhanced Funding Request Please check applicable funding period: January to June July to December Funding Start Date: Funding End Date: Total # of days for funding period (add # of days from start to end dates): Total hours required per day: Mon Tues Wed Thurs Fri Alt. Fri Is extra support required on PA days/school breaks? Yes Number of Hours: No Community and Health Services Department Social Services Branch

7 Section F Signatures I hereby apply for funding services and declare that the above information is true to the best of my knowledge. This application will be shared with: This application will be shared with: a) York Region, Community and Health Services Department, Social Services Branch b) The Child Care Enhancement Committee Parent/Guardian Signature Date Child Care Setting Supervisor Signature Date Consultant Signature (i.e. Early Interventionist) Date To be eligible for funding, parents/guardians of children with exceptional special needs must need child care while they are at work or in school. To verify this, attach a letter of employment or education schedule for each parent/guardian (for example, Mon to Fri 9 am - 5 pm; Mon, Wed & Fri 8 am - 1 pm). For re-applications, please sign below if employment and/or educational program for parent(s) has not changed since the last application period. Parent/Guardian Signature Supervisor Signature Enhanced Funding is intended as a short-term measure to help implement strategies for including children with exceptional special needs. Document below how time and supports will be reduced over the duration of the funding period. Community and Health Services Department Social Services Branch