Free school meals application form

D. DWP BENEFITS / INLAND REVENUE TAX CREDITS Which benefits / tax credits do you receive?
Tick box
Income support or Income-based Job Seeker’s Allowance (JSA)
Income-related Employment Support Allowance (ESA)
Child Tax Credit with no entitlement to Working Tax Credit and an annual income below £16,190
Guarantee Element of Pension Credit
Support under part VI of the Asylum Act 1999
E. EQUAL OPPORTUNITIES MONITORING POLICY
Lewisham Pupil Support wants to ensure that we continue to provide our benefits to those families in need
from all areas of the community. You are not required to complete this section to receive assistance.
Are you, the claimant, male or female? Male Female
Do any of your children have a physical disability or Special Needs? Yes No
Are you a single parent? Yes No
Have you applied to Lewisham for free school meals before? Yes No
How would you describe your ethnic origins? Please tick one of the boxes below.
Asian Black White Mixed
Bangladeshi African British Mixed ethnicity
Indian Caribbean Irish
Pakistani British Turkish
Arab Other black Greek
Chinese Other white
Vietnamese
Other Asian
How to apply
You can hand this form into any AccessPoint, your child’s school or post it to us.
Schools will not issue a free meal until they receive a free meal authorisation from Lewisham. If you see an officer at
AccessPoint at Catford or Downham they will issue you with an authorisation which you should take into your child’s
school. If you post your form to us or hand it to your child’s school we will send a meals authorisation directly to the
school. This will be valid from the date we receive your form but may take a day or more to arrive.
If we are unable to confirm your entitlement to free school meals we will write to you to request additional
information.
General information
This application lasts for one year. We will write to you to renew your application when this form is due to expire.
You must let us know if your benefit stops or changes or you change address. If you children start a new school, that
school will not issue free meals until they receive a meals authorisation.
OFFICE USE ONLY Initial and date QA 1
Hub check QA 2
On list QA 3
Schools notified Other
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