Application Form - St John's School and Community College

APPLICATION FOR FREE SCHOOL MEALS
PLEASE NOTE: Free School Meals can only be awarded if parents or guardians (not foster
parents) are in receipt of either
Income Support or Income Based Jobseekers Allowance
or Child Tax Credit and whose annual income (as assessed by the Inland
Revenue) does not exceed £16190. Your tax credit notice (Form TC602) will
tell you this.
or Guaranteed element of the state pension credit
or Support under part VI of the Immigration & Asylum Act 1999
or Income related employment support allowance
Free School Meals are not available to pupils of Parents/Guardians who receive
Working Tax Credit.
Please tick box if this is your first application
Only one application is required per family
SECTION A
National Insurance Number (parent/guardian)
Surname (parent/guardian) First Name Mr/Mrs/Miss/Ms
Home Address
Postcode
Telephone Number
Relationship to student (mother, father, guardian etc)
Please give details of All dependant children living at home attending St John’s School. If you have younger
children due to start at St John’s in September please include them also.
Forenames (Children) Surname Date of Birth Tutor Group
St John’s Marlborough
spw/FSM/application Granham Hill, Marlborough, Wiltshire SN8 4AX T:01672 516156

SECTION B
PLEASE NOTE: Applications will not be accepted without recent proof of Income Support,
Income Based Job Seekers Allowance or Child Tax Credit (Form TC602 from the Inland Revenue
which shows you are NOT entitled to Working Tax credit and your annual income is less than
£16190). If you do not have recent proof of Income support or Income Based Job Seekers
Allowance, please ask the Social Security Office to endorse your claim at the bottom of this form.
I certify that the information given on this application form is to the best of my knowledge and belief correct.
I undertake to notify the Headteacher immediately of any changes in the payment of benefit.
I authorise the Social Security Office to confirm, if necessary by telephone, my entitlement to benefits.
Signature of applicant:
Date:
THE COMPLETED FORM together with recent proof of your benefits should be returned to the FSM
Administrator – St John’s School & Community College, Granham Hill, Marlborough, Wiltshire, SN8 4AX
SECTION C
If you do not have any documentary evidence of Income Support, Income Based Job Seekers
Allowance, you may ask the Social Security Office to complete this section:
I certify that the applicant is currently in receipt of:
Income Support
Income Based Job Seekers allowance
National Insurance Number (parent/guardian)
Signature:
Date:
Social Security Office Stamp
St John’s Marlborough
spw/FSM/application Granham Hill, Marlborough, Wiltshire SN8 4AX T:01672 516156