School Meals - please read the form, print it off and post as stated in the instructions.

 

CONFIDENTIAL

FORM FM1

APPLICATION FOR FREE SCHOOL MEALS

a

Section 1 – Details of Parent / Guardian / Carer

 

APPLICANT’S FULL NAME (Mr/Mrs/Miss/Ms)

………………………………………………………………………………………

 

 

Relationship to child / children

………………………………………………………………………………………………………

 

 

National Insurance No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Date of Birth ………. / ………. / ……….

 

 

 

Current Address

………………………………………………………………………………………………………………………...

 

…………………………………………………….

Postcode

……………………..

Tel No

……………………………….

 

 

Date of taking up residence at current address ……. / ……. / ……. / ……. Details of previous address ……………………….

 

……………………………………………………………………………………………………………………………………………...

Is this your first claim from DCC?  YES / NO

Have you applied previously under another name? YES / NO

 

If yes, please state previous name(s) …………………………………………………………………………………………………

 

 

Section 2 – Children (Please include all children on one form)

 

 

Child(ren)’s name and surname

Name of school or college

D.O.B.

Age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Eligibility:  To be eligible for free school meals you or your partner must be in receipt of Income Support or Income based Jobseeker’s Allowance, or the guarantee element of State Pension Credit; or Child Tax Credit (with an annual income of less than £16,190).  Those claiming Working Tax Credit are not eligible.

 

 

You will no longer be required to provide documentary verification of benefits received, unless requested to do so. The Council will undertake routine eligibility checks on all current claims throughout the year. Please contact us immediately if your benefit changes or ends, as it may mean that you no longer qualify for free school meals.

 

 

Data Protection Act

Personal information that you have provided will be used carefully and may be held on computer systems at the school/college and in the Children and Younger Adults Department.  The use of this personal information is covered by registration under data protection legislation.  Under the legislation you have the right to obtain a copy of the information that we hold about you.

 

 

 

Section 3 – Declaration

 

 

 

 

I certify that the above information is correct to the best of my knowledge and belief, and that I am legally responsible for the children for whom I have claimed.  I understand that Derbyshire County Council may verify the information given with Government Departments.  I understand that if I fail to inform you of any change in circumstances, and my children continue to receive free meals, I may be required to repay the cost of any meals consumed.

 

Signature of Claimant  ………………………………

Date …………………………………..

 

 

 

A deliberate false statement may lead to prosecution.

 

Families who have children who are 2 years of age may also be eligible for up to 15 hours per week funded nursery places.  For more details and to see if you are eligible please contact 01629 39317.

 

Please return this form to the address below.  If the form is not fully completed, your application may be delayed.

 

Derbyshire County Council, CAYA Free School Meals, Chatsworth Hall (Block B), Matlock, DE4 3FW 

Tel: (01629) 536481 / 536475

 

 

Applications for FSM can be made by requesting a form from

 

CAYA Catering Services, contact the FSM Team on 01629 536704 who will post a form out Requesting an application form from any Derbyshire School or

On line at www.derbyshire.gov.uk/freeschoolmeals

 

Checks can be made over the telephone, to identify if the claim once submitted will be successful – but need to be followed up by the form to establish the claim.

 

Claims should be processed within 7 days (5 working days from receipt of the application form, electronic or paper).

 

Once received the team will do the necessary checks using the National Insurance Number and Date of Birth of the applicant against the live link to the Department of Work and Pensions database. 

 

When it is known whether the claimant is eligible or not, a letter will be sent to the family advising.  A copy of the letter will be sent to the Clerical Staff in School.

 

Frequent reports are produced and sent to school listing all eligible pupils within the schools and also identifying pupils who are no longer eligible due to changes in family circumstances.

 

Schools get the premium.

 

Once established the pupil remains eligible throughout their school life in Derbyshire, regardless of changing schools.  There is no need to reapply.

 

FSM Team need to be made aware of siblings joining schools, this can be done over the telephone, or by submitting an additional application form.

 

We request families who do have changes to their circumstances/benefits advise us – however the regular reports produced will flag up families no longer eligible and in these circumstances both the school and family will be notified.