Isle of Wight Council

Application for Free School Meals This form should be completed by the parent/guardian with whom the child lives with Please do not complete this form if you receive Working Tax Credit as you are not entitled to receive free school meals Before you complete this application, please ensure that you read the frequently asked questions relating to Free School Meals Details of parent/legal guardian claiming one of the benefits listed below: Title Mr Mrs Ms Miss other... Please enter your title Forename/s Any other names you have used Surname or last name Your address Building/house name/number Street address Town Name County Postcode Daytime telephone number (i.e. 01983 821000) Email address Your Date of Birth National Insurance Number Relationship to child or children Details of children who are in Full Time Attendance at school for whom you are claiming free school meals First Childs Details Child's Forename Child's Middle name/Initials Child's Surname Child's Date of Birth Year Group Name of school Is the childs address the same as yours Yes No Building/house name/number Street address Town Name County Postcode Child 2 Details Is there a second child Yes No Child's Forename Child's Middle name/Initials Child's Surname Child's Date of Birth Year Group Name of school Is the childs address the same as yours Yes No Building/house name/number Street address Town Name County Postcode Child 3 Details Is there a third child Yes No Child's Forename Child's Middle name/Initials Child's Surname Child's Date of Birth Year Group Name of school Is the childs address the same as yours Yes No Building/house name/number Street address Town Name County Postcode Child 4 Details Is there a fourth child Yes No Child's Forename Child's Middle name/Initials Child's Surname Child's Date of Birth Year Group Name of school Is the childs address the same as yours Yes No Building/house name/number Street address Town Name County Postcode Child 5 Details Is there a fifth child Yes No Child's Forename Child's Middle name/Initials Child's Surname Child's Date of Birth Year Group Name of school Is the childs address the same as yours Yes No Building/house name/number Street address Town Name County Postcode Supporting Evidence It is essential that you *attach documentary proof of one of the benefits listed below, dated within the last 3 months. Free school meals cannot begin until the appropriate evidence has been seen, and cannot be back dated. *Please forward your supportive documents to: School Admissions Schools and Learning Division Isle of Wight Council County Hall Newport Isle of Wight PO30 1UD Or email them to [email protected] At least one option must be selected below, Free school meals cannot be given without this a) Income Support Yes No b) Employment Support Allowance (Income Related) Yes No c) Income based Job Seekers Allowance Yes No d) Guaranteed Pension Credit Yes No e) Support under part VI of the Immigration and Asylum Act 1999 Yes No f) Child Tax Credit with an annual taxable household income assessed by HMRC of less that £16,190. (If you or your partner are entitled to Working Tax Credit, you do not qualify for Free School Meals regardless of your income) Yes No NB [From 1st May 2009, where a parent is entitled to Working Tax Credit during a 4-week period immediately after employment ends, OR after they start work less that 16 hours per week, they will be eligible to claim Free School Meals for that 4-week period] Your application will automatically be checked using the department for Children, School and Families (DCSF) Eligibility Checking System. However, we may request proof of your income if we are unable to establish your entitlement to free school meals through those departments. Free school meals will only commence upon receipt of a completed form and, if requested, relevant evidence. Free school meals cannot be back dated. Declaration I will notify Isle of Wight Council if my benefit is stopped/changed and I understand if I do not do this or give false information I will have to repay the cost of any meals taken free to which my children were not entitled. I agree that you will use the information provided to process my claim and will contact other sources as allowed by law to verify my initial and ongoing entitlement. I understand that this information may also be used to assess entitlement to receive free travel to school for my children. I understand that I can contact you and withdraw my consent for you to use this information for these purposes at any time. Please indicate to confirm you have read and accept these terms and conditions I agree I don't agree Date 07 Mar 2013 Data Protection Act 1998 The information you supply on this form regarding your child will be held on computer or other filing system and may be checked against other information held by the Isle of Wight Council and any other related agency. Your child’s information is covered by the Data Protection Act 1998 which gives you the right to see it if you want to by application to the Director of Children and Young People, County Hall, Newport PO30 1UD For office use only Recieved ......../......../......... Copied To Transport Eligibility Y/N Copied To Transport CHS752 Data Protection Act 1998 Data Protection Act 1998 This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. Receive Emails If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. Your Information If you wish your non-sensitive personal information to be held by the Council please tick this box Submitting your form Now you should submit your form by pressing the submit button below Your reference number will be provided once submittedThe submission date will set when submitted Reference Number NOT SUBMITTED YET Date Of Submission NOT SUBMITTED YET