• Claimant Details
• Children's Details
• Benefits
• Declaration
• Completion

About you

Tell us who you are*

If you are not the claimant, please enter your name and your relationship to the claimant.

Relationship: Maximum 100 characters

About the claimant

Title* Miss Ms Mr Mrs

Forename*

Surname*

Date of birth* Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934

Address Line 1*

Address Line 2

Town*

County*

Postcode*

Telephone

Method of contact

Please provide an email address which we may use for future contact with you about this claim. It is your responsibility to take appropriate security measures on your email account. If you are completing this application for someone else please make sure that the email address you enter is for the person who is applying for the free meals and not the person completing the form.

Email address

Your consent

I agree that you will use the information I have provided to process my claim for free school meals to verify my initial, and ongoing entitlement and that you may contact other sources as allowed by law to confirm this. I also agree that should my initial application be refused further checks will be periodically automatically made for 30 days to see if I later become entitled.*

I agree that you can inform the school(s) attended by my child(ren) of their initial and ongoing entitlement to free school meals. I also understand that the results of any eligibility check may also be used to assess entitlement to receive free travel to school or eligibility of the Early Years Pupil Premium for my child’s nursery (where appropriate), or to create a claim for free school meals for a sibling at a later date.*

I agree that the information provided on this application form will be used to ensure that the council’s records are correct and may also be shared with other agencies and service providers to ensure that my family receives an appropriate service. The full Data Protection statement can be found at Your Data .*

I agree that the information I have provided is true to the best of my knowledge, and understand that any false or deliberately misleading information provided on this form and/or supporting papers may render this application invalid and could lead to the withdrawal of free school meals.*

I agree that that the Free School Meals Entitlement Service can contact any relevant agencies in order to validate this application.*