Please Provide Proof of Entitlement from the List Overleaf

FREE SCHOOL MEALS & BURSARY APPLICATION FORM

Please return form with supporting For Office Use Only documentation to: Eligibility Checked: Priestley College Free School Meal: Yes / No Student Services Bursary: Yes / No Award: Loushers Lane Date Approved: Warrington Approved By: WA4 6RD APPLICATION FOR: (Tick all FREE SCHOOL BURSARY that apply) MEAL

SECTION 1: STUDENT(S) & PARENT/CARER DETAILS Application can be for more than one sibling attending the College. SURNAME FIRST NAMES STUDENT I.D. Student No. 1 Student No. 2 Student No. 3

SURNAME FIRST NAMES Date of Birth Parent/Carer Address: Home Telephone Number Mobile Telephone Number e-mail address

Please state the relationship with student Do you have any other dependents attending full- time education, not including Higher Education? Please state number Was the student eligible for Free School Meals in YES / NO yr11? Did the student receive Free School Meals in yr11? YES / NO SECTION 2: To be completed by students if living independently from parents/carers Note: please complete contact details above before submitting form. Please tick relevant category. Ye No Confirmed by Priestley s College Young People in Care Care Leavers In receipt of Income Support or Universal Credit In receipt of Employment Support Allowance together with Disability Living Allowance (or Personal Independence Payments) SECTION 3: DECLARATION I/we certify that the above information is correct to the best of my knowledge and FREE SCHOOL MEALS & BURSARY APPLICATION FORM

belief. I/we understand that the information I/we have supplied for free school meals/bursary might be shared with the Education Funding Agency as required under the Apprenticeships, Skills, Children and Learning Act 2009. I/we undertake to notify the College of any change in my/our circumstances. I/we accept the terms and conditions of the award of the bursary as detailed overleaf.

Student Signature: Date:

Parent/Carer Signature: Date:

Please provide proof of entitlement from the list overleaf. In order to qualify for Free School Meals, the claimant must be in receipt of one of the following benefits:

BENEFIT PROOF OF BENEFIT INCOME SUPPORT Current letter of entitlement to Income Support INCOME BASED JOB SEEKERS Current letter of entitlement to Income ALLOWANCE Based Jobseekers allowance CHILD TAX CREDIT but only those who Tax Credit Award notice as supplied by are not entitled to a Working Tax Credit* Inland Revenue for the current tax year. and whose annual income (as assessed * Tax credit award notice as supplied by by the Inland Revenue) does not exceed the Inland Revenue for the current tax £16,190 (subject to annual review), or year and proof of the date employment Working Tax Credit ‘run-on’ – the ceased or the date employment of less payment someone may receive for a than 16 hours per week started. further four weeks after they stop qualifying for Working Tax Credit. SUPPORT UNDER PART VI OF THE IMMIGRATION AND ASYLUM ACT Vouchers as supplied by Inland Revenue. 1999 GUARANTEE ELEMENT OF STATE Pension Credit Award Notice (M1000) PENSION CREDIT INCOME RELATED EMPLOYMENT Current letter of entitlement to Income Related AND SUPPORT ALLOWANCE (ESA) Employment and Support Allowance UNIVERSAL CREDIT Current letter of entitlement to Universal Credit

BURSARY TERMS & CONDITIONS

An application for mainstream bursary support may be made by any student who meets the criteria above for Free School Meals, was in receipt of Free School Meals in Year 11 or where the household income is less than £21,000 per annum. Evidence of household income will be required.

 The College will be immediately informed of any change in financial circumstances.  Any student leaving their learning programme will not be eligible to receive further payments and any over-payments may have to be repaid.  The information supplied in this application may be shared with other agencies or organisations, as allowed by law, for the purposes of checking this application and/or the FREE SCHOOL MEALS & BURSARY APPLICATION FORM

prevention of fraud.  The young person must be eligible on residency grounds and suitable evidence of residency is made available, if required.  The student must maintain an attendance pattern that is no less than95% for all learning sessions over a given period.  The student must comply with any conditions set out in a behaviour contract in line with the College’s disciplinary/monitoring procedures where applicable.  The student must make good progress against given targets that may include the completion of coursework.  The student must complete all assessments/examinations as required.  Any false statement in relation to claims for support from the Bursary Fund will lead to payments ceasing with immediate effect and disciplinary/legal action may be taken to recoup any funds that are deemed to have been inappropriately allocated. All cases of fraud will be reported to the appropriate authorities.