FREE SCHOOL MEALS AND PUPIL PREMIUM APPLICATION
Dear Parent/Guardian,
We want to make sure that we are providing your child with the best education and
support we can. Healthy school food has obvious health benefits and can help pupils
establish healthy habits for life. Healthy school food can also help to improve pupils’
readiness to learn.
Families who receive certain benefits may be eligible for free school meals. Your
child is eligible for free school meals if you’re in receipt of one of the following
benefits:
• Universal Credit with an annual net earned income of no more than £7,400.
• Income Support
• Income-based Jobseeker’s Allowance
• Income-related Employment and Support Allowance
• Support under Part 6 of the Immigration and Asylum Act 1999
• The guarantee element of Pension Credit
• Working Tax Credit run-on (paid for the four weeks after you stop qualifying for
Working Tax Credit)
• Child Tax Credit (with no Working Tax Credit) with an annual income of no more
than £16,190
Registering for free meals could also raise an extra (£1,320 for your child’s primary
school) (£935 for your child’s secondary school), to fund valuable support like extra
tuition, additional teaching staff or after school activities.
This additional money is available from central government for every child whose
parent is receiving one of the benefits listed above.
To check if your child is eligible, we need information about you and your child.
Please complete this form and return to your child’s school
ABOUT YOUR CHILD/CHILDREN
Child’s Last Name Child’s First Name Child’s Date Name of School
of Birth
04/18
PARENT/GUARDIAN DETAILS
Parent/Guardian 1 Parent/Guardian 2
Last name
First Name
Date of Birth
National Insurance
Number*
National Asylum Support
Service (NASS) Number* / / / /
Daytime Telephone
Number
Mobile Number
Address
Postcode: Postcode:
* Complete as appropriate
FAMILY INCOME AND BENEFIT DETAILS
If you receive any of the benefits listed below, please place an X in this
box:
Income Support
Income-based Jobseekers Allowance
Income-related Employment and Support Allowance
Support from NASS (National Asylum Support Service)
under part 6 of the Immigration and Asylum Act 1999
the guarantee element of State Pension Credit
Child Tax Credit (with no Working Tax Credit) with an annual
income of no more than £16,190
Working Tax Credit run-on after work ends
Universal Credit. – see below
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.
Yes No Unsure
Child Tax Credit
04/18
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.
Yes No Unsure
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.
Signature of parent/guardian: ………………………………………………………….
Date:……………………….
Thank you for completing this form and helping to make sure your child’s
school is as well funded as possible.
How the information in this form will be used
The information you provide in this form will be used by the council to confirm receipt
of one of the listed welfare benefits. Once this is confirmed, this helps to decide how
much money your child’s school will receive each year.
The information will also be used in relation to pupils in year 3 or above to decide
whether they are eligible for free school meals.
You only need to complete this form once and it will last for the duration of your
child’s time at their current school. You should contact the school or local authority if
you have a change in financial circumstances.
We are committed to ensuring that the personal and sensitive information that we
hold about you is protected and kept safe and secure, and we have measures in
place to prevent the loss, misuse or alteration of your personal information. We will
use the information you provide to assess entitlement to free school meals. The
information may also be shared with other Council departments to offer benefits and
services.
Your completed form should be returned to the Headteacher or can be sent to
Free School Meals, Norfolk County Council, Floor 8, County Hall, Norwich, NR1
2DL
04/18
