3
If you do not sign the form, your application may be delayed and your child may not receive free school meals.
Once we receive your completed application for Free School Meals we will check your benefit entitlement with
data held by Department for Work and Pensions, the Home Office and HMRC (Revenue and Customs) through
Department for Education Eligibility Checking System (ECS).
FREE SCHOOL MEALS/
PUPIL PREMIUM APPLICATION 2019/2020
We want to make sure that we are providing your child with the best education and support we can.
Healthy school food has obvious health benefits and can help pupils establish healthy habits for life.
Healthy school food can also help to improve pupils’ readiness to learn.
Families who receive certain benefits may be eligible for free school meals. Your child is eligible for
free school meals if youre in receipt of one of the following benefits:
• Universal Credit with an annual household net earned income of no more than £7,400
• Income Support
• Income-based Jobseekers' Allowance
• Income-related Employment and Support Allowance
• Support under Part 6 of the Immigration and Asylum Act 1999
• The guaranteed element of Pension Credit
Working Tax Credit run-on (paid for the four weeks after you stop qualifying for
Working Tax Credit)
Child Tax Credit (with no Working Tax Credit) with an annual income of no more than £16,190
Children who receive a qualifying benefit in their own right are also allowed to receive free school meals. Children
under the compulsory school age who are in full time education may also be entitled to receive free school meals.
Registering for free meals could also raise an extra £1,320 for your child’s primary school and £935 for your child’s
secondary school, to fund valuable support like extra tuition, additional teaching staff or after school activities.
This additional money is available from central government for every child whose parent is receiving one of the
benefits listed above.
To check if your child is eligible, we need information about you and your child. Please complete this form and
return to FSM, School Admissions, PO Box 1057, Wembley, Middlesex HA9 1HJ.
If you receive benefits please apply using this form to ensure that your child’s school receives this important
extra funding – even if you don’t want your child to receive a free meal.
You must complete all sections of the application form, including all details of each child attending a school
in Brent and sign the declaration statement. We may contact you if any more information is required.
Please note: For children in schools not in Brent you will have to apply to the borough that maintains the
school. Eligibility for free school meals will not be backdated.
www.brent.gov.uk/freeschoolmeals
www.brent.gov.uk/freeschoolmeals
I declare that I am the person with parental responsibility for the child named above and the information I have given on
the form is true to the best of my knowledge and belief.
I declare that the information given on this form is correct. I agree to inform Brent Council if the children change school,
home address or stop receiving any of the eligible benefits. I authorise Brent Council to check the details provided with
any relevant body, to check the internal council database and the DfE Eligibility Checking Service to verify benefits.
I understand that making a false declaration is a serious matter and could render me liable to prosecution.
I agree that you will use the information I have provided to process my claim for free school lunches and will
contact other sources as allowed by the law to verify my initial, and ongoing, entitlement.
The information I have given on this form is complete and accurate. I understand that my personal information is held
securely and will be used only for local authority purposes. I agree to the local authority using this information to process
my application for free school meals. I also agree to notify the local authority in writing of any change in my family’s
financial circumstances as set out in this form.
Signature of parent/guardian..........................................................................................
Full name......................................................................................... Date (DD/MM/YYYY) ..................................................
Thank you for completing this form and helping to make sure your child’s school is as well funded as possible.
The information you provide in this form will be used by the council to confirm receipt of one of the listed welfare
benefits. Once this is confirmed, this helps to decide how much money your child’s school will receive each year.
The information will also be used in relation to pupils aged 3 or above to decide whether they are eligible for free school meals.
You only need to complete this form once and it will last for the duration of your child’s time at their current phase of
education (primary or secondary).
You should contact the school or local authority if you have a change in financial circumstances.
We are committed to ensuring that the personal and sensitive information that we hold about you is protected and kept
safe and secure, and we have measures in place to prevent the loss, misuse or alteration of your personal information.
We will use the information you provide to assess entitlement to free school meals. The information may also be shared
with other Council departments to offer benefits and services.
You are providing your information to Brent Council, contact details school.admissions@brent.gov.uk. The Council’s Data
Protection Officer can be contacted via dpo@brent.gov.uk, or 020 8937 1402.
Your information is collected for the purpose of assessing eligibility for free school meals and the pupil premium, as
required to fulfil the council’s duties under The Education Act 1996, The Welfare Reform Act 2012 and the Children and
Families Act 2014.
The information will be shared with the Department for Education for the purposes of checking eligibility and schools
in Brent for the purposes of notifying them of a child’s entitlement to free school meals and/or the pupil premium. The
information shall be retained for six years after the end of your child’s education and shall be processed in adherence
to your legal rights, including but not limited to the right to withdraw consent, right to copies of your information and
right to be forgotten. If you are dissatisfied with the processing of your information, you can raise your concern with
the council’s data protection officer. You have a right to lodge a complaint with the Information Commissioner’s Office
(www.ico.org.uk).
Further information can be found at www.brent.gov.uk/privacy
Declaration
How the information in this form will be used
GDPR privacy notice
*BRSA106* Free School Meals Application
If you receive any of the benefits listed below, please place an X in this box.
FREE SCHOOL MEALS/PUPIL PREMIUM
APPLICATION FORM 2019/2020
Child(ren) details
Please complete one box for each child you wish to receive free school meals. If you are claiming for more than four
children, please complete additional details on a separate form.
Please complete the application by signing the declaration overleaf.
1
Mr
MrsMissMsOther
Day MonthYear
2
Family income and benefit details
• Income Support
• Income-based Jobseekers' Allowance
• Income-related Employment and Support Allowance
Support from NASS under part 6 of the Immigration and
Asylum Act 1999
• The guaranteed element of Pension Credit
• Child Tax Credit (with no Working Tax Credit)
• Working Tax Credit run-on
• Universal Credit.
Details of the Parent/Guardian in receipt of one of the benefits
Title (please tick
relevant box)
Parent/guardian
first name
Parent/guardian
surname
Current family
address
Postcode
Parent/Guardian
Date of birth
Landline number
Mobile number
Email address
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
First child
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
Second child
If you are in receipt of Universal Credit, is your net earned family income over £7,400 per year? (Please place an X in
the appropriate box).
Universal Credit
Your net earned income is your household income after taxes and deductions. It does
not include income through Universal Credit or other benefits that you may receive.
If you are in receipt of Child Tax Credit, is your joint gross annual income over £16,190 per year? (Please place an X in
the appropriate box).
Child Tax Credit
Your joint gross income is your household
income before taxes are taken into account.
National Insurance Number
or
National Asylum Support
Service Reference Number
Yes No Unsure
Yes No Unsure
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
Third child
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
Fourth child
If you’re not sure whether you receive one of the listed benefits, or what your household income is, but you
would still like us to check whether your child is eligible for free school meals, please place an X in this box.
*BRSA106* Free School Meals Application
If you receive any of the benefits listed below, please place an X in this box.
FREE SCHOOL MEALS/PUPIL PREMIUM
APPLICATION FORM 2019/2020
Child(ren) details
Please complete one box for each child you wish to receive free school meals. If you are claiming for more than four
children, please complete additional details on a separate form.
Please complete the application by signing the declaration overleaf.
1
Mr
MrsMissMsOther
Day MonthYear
2
Family income and benefit details
• Income Support
• Income-based Jobseekers' Allowance
• Income-related Employment and Support Allowance
Support from NASS under part 6 of the Immigration and
Asylum Act 1999
• The guaranteed element of Pension Credit
• Child Tax Credit (with no Working Tax Credit)
• Working Tax Credit run-on
• Universal Credit.
Details of the Parent/Guardian in receipt of one of the benefits
Title (please tick
relevant box)
Parent/guardian
first name
Parent/guardian
surname
Current family
address
Postcode
Parent/Guardian
Date of birth
Landline number
Mobile number
Email address
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
First child
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
Second child
If you are in receipt of Universal Credit, is your net earned family income over £7,400 per year? (Please place an X in
the appropriate box).
Universal Credit
Your net earned income is your household income after taxes and deductions. It does
not include income through Universal Credit or other benefits that you may receive.
If you are in receipt of Child Tax Credit, is your joint gross annual income over £16,190 per year? (Please place an X in
the appropriate box).
Child Tax Credit
Your joint gross income is your household
income before taxes are taken into account.
National Insurance Number
or
National Asylum Support
Service Reference Number
Yes No Unsure
Yes No Unsure
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
Third child
//
First name
Surname
Date of birth
Brent school
name
School
postcode
Yes No
Have you previously applied to Brent for free school meals?
School attendance start date
Male Female
Fourth child
If you’re not sure whether you receive one of the listed benefits, or what your household income is, but you
would still like us to check whether your child is eligible for free school meals, please place an X in this box.
3
If you do not sign the form, your application may be delayed and your child may not receive free school meals.
Once we receive your completed application for Free School Meals we will check your benefit entitlement with
data held by Department for Work and Pensions, the Home Office and HMRC (Revenue and Customs) through
Department for Education Eligibility Checking System (ECS).
FREE SCHOOL MEALS/
PUPIL PREMIUM APPLICATION 2019/2020
We want to make sure that we are providing your child with the best education and support we can.
Healthy school food has obvious health benefits and can help pupils establish healthy habits for life.
Healthy school food can also help to improve pupils’ readiness to learn.
Families who receive certain benefits may be eligible for free school meals. Your child is eligible for
free school meals if youre in receipt of one of the following benefits:
• Universal Credit with an annual household net earned income of no more than £7,400
• Income Support
• Income-based Jobseekers' Allowance
• Income-related Employment and Support Allowance
• Support under Part 6 of the Immigration and Asylum Act 1999
• The guaranteed element of Pension Credit
Working Tax Credit run-on (paid for the four weeks after you stop qualifying for
Working Tax Credit)
Child Tax Credit (with no Working Tax Credit) with an annual income of no more than £16,190
Children who receive a qualifying benefit in their own right are also allowed to receive free school meals. Children
under the compulsory school age who are in full time education may also be entitled to receive free school meals.
Registering for free meals could also raise an extra £1,320 for your child’s primary school and £935 for your child’s
secondary school, to fund valuable support like extra tuition, additional teaching staff or after school activities.
This additional money is available from central government for every child whose parent is receiving one of the
benefits listed above.
To check if your child is eligible, we need information about you and your child. Please complete this form and
return to FSM, School Admissions, PO Box 1057, Wembley, Middlesex HA9 1HJ.
If you receive benefits please apply using this form to ensure that your child’s school receives this important
extra funding – even if you don’t want your child to receive a free meal.
You must complete all sections of the application form, including all details of each child attending a school
in Brent and sign the declaration statement. We may contact you if any more information is required.
Please note: For children in schools not in Brent you will have to apply to the borough that maintains the
school. Eligibility for free school meals will not be backdated.
www.brent.gov.uk/freeschoolmeals
www.brent.gov.uk/freeschoolmeals
I declare that I am the person with parental responsibility for the child named above and the information I have given on
the form is true to the best of my knowledge and belief.
I declare that the information given on this form is correct. I agree to inform Brent Council if the children change school,
home address or stop receiving any of the eligible benefits. I authorise Brent Council to check the details provided with
any relevant body, to check the internal council database and the DfE Eligibility Checking Service to verify benefits.
I understand that making a false declaration is a serious matter and could render me liable to prosecution.
I agree that you will use the information I have provided to process my claim for free school lunches and will
contact other sources as allowed by the law to verify my initial, and ongoing, entitlement.
The information I have given on this form is complete and accurate. I understand that my personal information is held
securely and will be used only for local authority purposes. I agree to the local authority using this information to process
my application for free school meals. I also agree to notify the local authority in writing of any change in my family’s
financial circumstances as set out in this form.
Signature of parent/guardian..........................................................................................
Full name......................................................................................... Date (DD/MM/YYYY) ..................................................
Thank you for completing this form and helping to make sure your child’s school is as well funded as possible.
The information you provide in this form will be used by the council to confirm receipt of one of the listed welfare
benefits. Once this is confirmed, this helps to decide how much money your child’s school will receive each year.
The information will also be used in relation to pupils aged 3 or above to decide whether they are eligible for free school meals.
You only need to complete this form once and it will last for the duration of your child’s time at their current phase of
education (primary or secondary).
You should contact the school or local authority if you have a change in financial circumstances.
We are committed to ensuring that the personal and sensitive information that we hold about you is protected and kept
safe and secure, and we have measures in place to prevent the loss, misuse or alteration of your personal information.
We will use the information you provide to assess entitlement to free school meals. The information may also be shared
with other Council departments to offer benefits and services.
You are providing your information to Brent Council, contact details school.admissions@brent.gov.uk. The Council’s Data
Protection Officer can be contacted via dpo@brent.gov.uk, or 020 8937 1402.
Your information is collected for the purpose of assessing eligibility for free school meals and the pupil premium, as
required to fulfil the council’s duties under The Education Act 1996, The Welfare Reform Act 2012 and the Children and
Families Act 2014.
The information will be shared with the Department for Education for the purposes of checking eligibility and schools
in Brent for the purposes of notifying them of a child’s entitlement to free school meals and/or the pupil premium. The
information shall be retained for six years after the end of your child’s education and shall be processed in adherence
to your legal rights, including but not limited to the right to withdraw consent, right to copies of your information and
right to be forgotten. If you are dissatisfied with the processing of your information, you can raise your concern with
the council’s data protection officer. You have a right to lodge a complaint with the Information Commissioner’s Office
(www.ico.org.uk).
Further information can be found at www.brent.gov.uk/privacy
Declaration
How the information in this form will be used
GDPR privacy notice
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