Free School Meals Application

Parent / Guardian 1

First Name

Surname

Date of Birth

National Insurance Number

National Asylum Support Service (NASS) Number (if applicable)

Parent / Guardian 2

First Name

Surname

Date of Birth

National Insurance Number

National Asylum Support Service (NASS) Number (if applicable)

Child(rens) Details

First Name (child 1)

Surname (child 1)

Year Group / Class (child 1)

First Name (child 2)

Surname (child 2)

Year Group / Class (child 2)

First Name (child 3)

Surname (child 3)

Year Group / Class (child 3)

Eligibility Checker - Does either parent receive any of the following, please select relevant box below

Universal Credit with an annual net earned income of no more than £7,400

Income Support

Income based Jobseeker's Allowance (IBJSA)

Support under Part VI of the Immigration and Asylum Act 1999

The guarantee element of Pension Credit

Child Tax Credit (with no Working Tax Credit) with an annual gross income of no more than £16,190, as assessed by HMRC. N.B. If you receive WORKING TAX CREDIT you do NOT qualify even if you receive child tax credit and your income is below £16,190.

Working Tax Credit run-on (paid for the four weeks after you stop qualifying for Working Tax Credit)

CRITERIA 2 - Application for other Pupil Premium

Is your child a looked-after child (LAC)? i.e. in the care of, or provided with accommodation by an English local authority?

Has your child ceased to be looked after by the local authority because of adoption, as special guardianship order, a child arrangements order or a residence order?

FOR PUPILS IN YEAR GROUPS RECEPTION TO YEAR 11: Are either or both parents regular members of HM Forces and designated as personal category 1 or 2 (PStat CAT 1 or 2), in the armed forces or another nation and stationed in England or in receipt of a child pension from the Ministry of Defence?

Declaration

I confirm that the details supplied are correct and accurate. I understand that my personal information is held securly and agree that the school can only use the information provided to process my claim for Free School Meals and / or Pupil Premium by contacting Babcock 4S, who will check entitlement via a secure government website.

I understand that I am responsible for informing the school immediately if I stop one of the qualifying benefits.

By signing this form I am confirming that I have read and fully understood the above declaration.

Signature

Clear

Date

N.B. This form must be signed by the person who is in receipt of any of the qualifying benefits.