Free school meals and pupil premium
Do you have a child in Primary or Secondary School that currently receives Free School Meals?
*
Do you have a child in Primary or Secondary School that currently receives Free School Meals?
Yes
No
Details of child already attending school
First Name
Last Name
Gender
Gender
Male
Female
Date of Birth (DD/MM/YYYY)
Date of Birth (DD/MM/YYYY)1
/
Date of Birth (DD/MM/YYYY)2
/
Date of Birth (DD/MM/YYYY)3
School Attended
Name of child
First Name
*
Last Name
*
Gender
*
Gender
Male
Female
Date of Birth (DD/MM/YYYY)
*
Date of Birth (DD/MM/YYYY)1
/
Date of Birth (DD/MM/YYYY)2
/
Date of Birth (DD/MM/YYYY)3
School Attending
*
Parent/Guardian details - must be benefit claimant
Title
*
Title
Mr
Mrs
Miss
Ms
Other
First Name
*
Last Name
*
Date of Birth (DD/MM/YYYY)
*
Date of Birth (DD/MM/YYYY)1
/
Date of Birth (DD/MM/YYYY)2
/
Date of Birth (DD/MM/YYYY)3
National Insurance Number
*
NI number must be in UPPERCASE and without any spaces.
National Insurance Number
*
Address
*
Postcode
*
Which council charges Council Tax for the address where you live?:
*
Which council charges Council Tax for the address where you live?:
Burnley
Chorley
Fylde
Hyndburn
Lancaster
Pendle
Preston
Ribble Valley
Rossendale
South Ribble
West Lancashire
Wyre
Email address
Phone/mobile
Family Income and benefit details
Select all that apply to you
Select all that apply to you
I am the parent/legal guardian of the child/children above and receive benefits for them
I receive Income Support or Income Based Job Seekers Allowance
I receive Income Related Employment and Support Allowance
I receive Child Tax Credit, my annual income is less than £16,190 and I don't receive Working Tax Credit
I receive the Guarantee Element of State Pension Credit
I receive support under Part VI of the Immigration and Asylum Act 1999
I receive Universal Credit
Declaration
Lancashire County Council will check your details with relevant government departments or other agencies to assess your initial and ongoing entitlement to free school meals, free travel to school and free school milk
*
Lancashire County Council will check your details with relevant government departments or other agencies to assess your initial and ongoing entitlement to free school meals, free travel to school and free school milk
I agree
Date
*
Date
28 Jun 2017
eForms
by AchieveForms
