Application form for free schools meals and uniform hardship

11+ Free School Meals Application Form
Student and Pupil Support, 3 rd Floor, Laurence House, London, SE6 4RU
Telephone 020 8314 6221 Email Pupil.Support@lewisham.gov.uk
This form is to apply for free school meals at Lewisham schools. If your children attend school in another
borough, apply to that borough for assistance. If your children attend an independent school or Academy apply
directly to the school. You need to complete a separate form to apply for hardship grants.
OFFICE USE ONLY Reference no:
Date received
Previous form
A. PARENT / GUARDIAN DETAILS
You Your partner
Last name*
First names*
Title
Date of birth*
National insurance number* or
NASS number
Previous names
Address
Postcode
Telephone number
If the sections marked with a * are
not complete we will not be able to
check your entitlement.
B. YOUR CHILDREN Give details of all the children in the family attending full time school up to the age of 18.
First name Last name Date of birth
Boy /
Girl
School attending from
September 2010
Your relationship to
this child
C. DECLARATION
I declare that the information I have given in this form is true and complete and I undertake to inform
Lewisham if my entitlement to one of the qualifying benefits stops. I further authorise Lewisham to contact
other sources as allowed by the law to verify my initial, and ongoing entitlement. I understand that the results
of any free school lunch eligibility check may also be used to assess my entitlement to receive free school milk
and hardship grants.
I further authorise that the data on this form may be held on a computer system which has been registered in
accordance with the Data Protection Act 1998 and may be shared with other local and national government
agencies in order to facilitate the processing of this or other applications for assistance including Student
Support and Housing Benefit.
Signature Date
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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
2

Grants are awarded to Lewisham residents whose children are
transferring to local authority maintained secondary schools or Academy which does not provide its own
grants. There is a limited fund available, and grants will be awarded on a first-come first-served basis.
OFFICE USE ONLY REF Date rec.
Parent/Guardian details
Last name*
First names*
Title
National insurance number*
APPLICATION FOR
SECONDARY TRANSFER
UNIFORM HARDSHIP GRANT
2010
Date of birth*
Address (you must be a
Lewisham resident)
Post code
Telephone number
You Your partner
Student and Pupil Support
3 rd Floor Laurence House
1 Catford Road
London
SE6 4RU
direct line 020 8314 6221
fax 020 8314 3019
*If these sections are not completed we will not be able to check your benefit entitlement.
Child’s details
First name Last name Date of birth Secondary school
Which benefit/tax credits do you receive? Please tick all that apply
Income support Income-based JSA
Income-related ESA Child Tax Credit only (income below £16,190)
Guarantee Element of Pension Credit Support under part VI of the Asylum Act 1999
Have you completed the Free School Meals 11+ Secondary Transfer form?
Yes We will use your free school meal application to check your entitlement. If you are entitled to free
school meals you do not need to provide any additional proof. If we are not able to check your
entitlement we will write to you to request further proof.
No You need to provide proof of your benefit with this application – turn over for details of the proof
we can accept. If you do not provide any proof your application will not be processed.
C. DECLARATION
I declare that the information I have given in this form is true and complete. I authorise that the data on this
form may be held on a computer system which has been registered in accordance with the Data Protection Act
1998 and may be shared with other local and national government agencies in order to facilitate the
processing of this or other applications for assistance including Student Support and Housing Benefit.
Signature Date
Completed forms must reach us 31 August 2010. Forms received after this date will not be accepted.
newforms.doc

Benefit proof was can accept
Income Support A letter dated after 1 May 2010 showing you receive
income support. Letters stating that deductions are being
made from your benefit cannot be accepted.
Income-based JSA or ESA A letter, dated after 1 May 2010 showing you receive
income-based JSA or ESA.
Guarantee Element of Pension Credit A copy of your Pension Credit award notice
Child Tax Credit without Working Tax Credit A copy of your tax award letter TC602. This must be for
and with an income below £16,190
the 2010/11 tax year.
NASS / Asylum Team payments A recent letter showing ongoing payments for you and
your children.
How to apply
You can hand this form into any AccessPoint or post it to us.
This form and any supporting proof must reach us by 31 August 2010.
Hardship fund grants
Grants are issued to Lewisham residents who have a child transferring to a local authority maintained
secondary school and who qualify for free school meals. Grants are issued by cheque.
OFFICE USE Initial and date QA 1
Fsm entitled QA 2
Grant awarded Other
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