Application for Free School Meal

Question Title

* 1. Your child may be able to get free school meals if you get any of the following:

Income Support

income-based Jobseeker’s Allowance

income-related Employment and Support Allowance

support under Part VI of the Immigration and Asylum Act 1999

the guaranteed element of Pension Credit

Child Tax Credit (provided you’re not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190)

Working Tax Credit run-on - paid for 4 weeks after you stop qualifying for Working Tax Credit

Universal Credit - if you apply on or after 1 April 2018 your household income must be less than £7,400 a year (after tax and not including any benefits you get)

Children who get paid these benefits directly, instead of through a parent or guardian, can also get free school meals.

Your child may also get free school meals if you get any of these benefits and your child is both:

younger than the compulsory age for starting school

in full-time education

If your child is eligible for free school meals, they’ll remain eligible until they finish the phase of schooling (primary or secondary) they’re in on 31 March 2022.

Surname/Family Name as it appears on your benefit letter

Forename

Title (Mr/Mrs/Miss/Dr...)

Question Title

* 2. Date of Birth

Date / Time

Date

Question Title

* 3. National Insurance Number OR National Asylum Seeker Number:

Question Title

* 4. Address

Address

Postcode

Telephone

Question Title

* 5. Details of Children (please include each child)

1. Surname/family name

1. Forename

1. Date of Birth

1. Name of School

2. Surname/family name

2. Forename

2. Date of Birth

2. Name of School

3. Surname/family name

3. Forename

3. Date of Birth

3. Name of School

4. Surname/family name

4. Forename

4. Date of Birth

4. Name of School

Question Title

* 6. By providing a date below you are declaring......

I declare that the information given on this form is true and complete and I undertake to inform the school if my entitlement to one of the qualifying benefits is terminated. I understand that the results of any free school meal eligibility check may also be used to assess my entitlement to other support/benefits, including free travel to school. The remainder of this declaration does not apply to pupils in Reception, Year1 or Year 2 - I agree that you will use the information I have provided to process my claim for free school meals and will contact other sources as allowed by law to verify my initial, and ongoing, entitlement to free school meals. I understand that I may be liable for any costs incurred in providing free school meals for my child(ren), should I fail to inform the school of the termination of my benefit.

Date / Time

Date