Application for Pupil Premium - Hampton Primary Partnership

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Information about you and your child - please complete one form for each child.

The information that you provide in the attached form to either Hampton Infant School and Nursery or Hampton Junior School will be used by the partnership for the purpose of checking your eligibility for free school meals or eligibility for school to claim additional grant money ('the pupil premium') from central Government. It will not be used for any other purpose and will remain confidential to Hampton Primary Partnership. Pupil Premium Grant (PPG) entitlement currently allows you to book places at holiday camps, you can apply for a PPG funded place at after school clubs (subject to availability) and AfC are currently providing supermarket vouchers during the holidays.

All applicants must complete the the form and by completing the form accept the declaration below. We cannot accept any applications unless this form has been completed in full.

Declaration: I hereby certify that the information given on this form is, to the best of my knowledge and belief, correct. I understand that any person knowingly giving any false information on this form, or providing any false documentation in support of it, may be liable to prosecution which could result in a fine and/or imprisonment.

All information provided will be treated in the strictest confidence.

Email *

Do you currently receive free school meals for the child you are applying for or any other children? *

Yes

Parent/Guardian 1 - Surname *

Parent/Guardian 1 - Forename *

Parent/Guardian 1 - Date of Birth *

YYYY

Parent/Guardian 1 - National Insurance or NASS Number *

Parent/Guardian 2 - Surname
*

Parent/Guardian 2 - Forename

Parent/Guardian 2 - Date of Birth

YYYY

Parent/Guardian 2 - National Insurance or NASS Number

Child's Surname *

Child's Forename *

Child's Date of Birth *

YYYY

School attending *

Hampton Infant School and Nursery

Hampton Junior School

Required

Current Address *

Daytime Contact Telephone Number *

Please tick which benefit, if any, you are receiving *

Universal Credit (provided you have an annual net earned income of no more than £7,400, as assessed by earnings from up to three of your most recent assessment periods)

Income Support

Income-based Jobseeker's Allowance

Income-related Employment and Support Allowance

Support under Part VI of the Immigration and Asylum Act 1999

The guaranteed element of Pension Credit

Child Tax Credit (provided you're not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190

Working Tax Credit run-on - paid for 4 weeks after you stop qualifying for Working Tax Credit

No benefits

A copy of your responses will be emailed to the address you provided.

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