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Free School Meal Eligibility Form

 
Child's Name
Date of Birth

Parent/Guardian Details

 
Full Name
Date of Birth
National Insurance Number
Telephone Number
Mobile Number
Address
Email Address
National Asylum Support Service (NASS) Number
 
Full Name
Date of Birth
National Insurance Number
Telephone Number
Mobile Number
Address
Email Address
National Asylum Support Service (NASS) Number

Family Income and Benefit Details:

If you receive any of the benefits listed below, please tick in the box given;

Select the relevant

Universal Credit
If you are in receipt of Universal Credit, is your net earned family income over £7,400 per year? (Please place an X in the appropriate box). Your net earned income is your household income after taxes and deductions. It does not include income through Universal Credit or other benefits that you may receive.

Child Tax Credit
If you are in receipt of Child Tax Credit, is your joint gross annual income over £16,190 per year? (Please place an X in the appropriate box). Your joint gross income is your household income before taxes are taken into account.

If you’re not sure whether you receive one of the listed benefits, or what your household income is, but you would still like us to check whether your child is eligible for free school meals, please tick below

DECLARATION
The information I have given on this form is complete and accurate. I understand that my personal information is held securely and will be used only for local authority purposes. I agree to the local authority using this information to process my application for free school meals. I also agree to notify the local authority in writing of any change in my family’s financial circumstances as set out in this form.

 
Signed (parent/carer)
Date