Free School Meal - Fort Pitt Grammar School

If you are eligible or become eligible in the future to apply for Free School Meals I wouldencourage you to make an application. Completed application forms should be handed to or sentto Reception (for the attention of Mrs Parle) and will be treated in the strictest confidence.Should you need any further information or advice regarding the completion of the form, please donot hesitate to contact a member of Student Support or Mrs Parle, who oversees Free SchoolMeals.Yours sincerelyMrs C A WinnHeadteacher

4. Full names of children attendingFort Pitt Grammar SchoolDate of BirthFormPlease note - If you have other children attending other schools you MUST complete a separateLEA application form.5. Have you applied for free meals before? YES NO6. STATEMENTPlease read this statement and sign it.Please note - to give false information may result in prosecution.These facts I have put down on this form are true and complete. I give consent for Fort PittGrammar School to make enquiries with the Benefits Agency or HM Revenue and Customs tocheck the information I have given. I will inform the school at once if my family or financialcircumstances change or I gain refugee status.Signed: ........................................................................................... Date: ........................................Thank you for completing this form. Please check that you have put your name and address onthis form. If you have any difficulty please contact Reception.7. INCOME SUPPORT/IBJSA/CHILD TAX CREDITTo be completed by the Benefits Agency responsible for payment of your benefit.I confirm that the above named person has been granted …………………………………………..from ......................................................................... until .................................................................Benefits Agency Official StampSigned: (Manager) ............................................…Date: ...........................................…..Official UseFree School Meals approved from: ....................................................................................................Expiry date of proof of entitlement: ...................................................................................................C:\Users\mbushell\Local Settings\Temporary Internet Files\Content.Outlook\0Y0WX19M\Free Meals Application Form.DOC / 13/02/2013