Form from: Florendine Primary School

Your child may be eligible to apply for Free School Meals (FSM) via Staffordshire County Council. Pupils who are eligible for Free School Meals enable the school to access additional funding which can then be used to further support pupils through high quality interventions to boost learning.

We can check if you are entitled on your behalf. Please complete the sections below and we will let you know if your claim has been successful.

PLEASE ENSURE THE INFORMATION PROVIDED IS ACCURATE AS ANY INCORRECT INFORMATION CAN RESULT IN AN UNSUCCESSFUL CLAIM

The most recent entitlement criteria is as follows:

a). Income Support

b). Income Based Job Seekers Allowance. Please note the ‘new style’ job seekers allowance is not a qualifying benefit, as this is based upon payment of National Insurance contributions and not the household income

c). Income Related Employment and Support Allowance. Please note the ‘new style’ employment and support allowance is not a qualifying benefit, as this is based upon payment of National Insurance contributions and not the household income

d). eligible for Child Tax Credit but not Working Tax Credit and the household income (as used by HMRC to assess tax credits) is not more that £16,190. Please note: anyone eligible for Working Tax Credit, or if you have a partner and they receive it, regardless of Income, you will not qualify

e). The Guarantee element of State Pension Credit

f). Support under part VI of the Immigration and Asylum Act 1999

g). In receipt of the 4 week run on of working tax credit (this is where someone becomes unemployed or reduces their hours and so is no longer entitled to working tax credit but will continue to receive it for a further 4 weeks and is entitled to free meals during that time)

h). Universal credit (provided you have an annual net earned household income of no more than £7,400 as assessed by earnings from up to three of your most recent assessment periods). Your net earned income is your household income after taxes and deductions and does not include income from Universal Credit or any other benefits you may receive.

I am entitled to (please select the option applicable from the list above

Pupil Name

Pupil D.O.B:

Class

Parent Full Name

Parent Date of Birth

Home Address

National Insurance Number

I give Florendine Primary School permission to apply for FSM on my behalf

Please sign below

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SCHOOL USE ONLY

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