Churchdown School Academy
APPLICATION FOR A
SCHOOL UNIFORM GRANT
School Year 2014-2015
This form should only be completed if you wish to apply for a School Uniform Grant for your child.
Successful approval will entitle you to a contribution towards the uniform required for Churchdown School Academy.Failure to complete the form in full will delay your claim.
To be completed by the person claiming the qualifying benefit and returned to: Carolyn Roberts at Churchdown School Academy - 01452 713340 Ext 285
Grants are only available to Parents or carers who receive either Income Support, Income Related Employment & Support Allowance, Income-Based Jobseeker’s Allowance (JSA), Support Under Part VI of the Immigration & Asylum Act 1999, Child Tax Credit, provided you are not entitled to Working Tax Credit and have an annual income (as assessed by Her Majesty’s Revenue and Customs) that does not exceed £16,190, or the Guaranteed element of State Pension.
A Your Details
B Name of child(ren) Please enter the details of each dependent child living at the above address for whom you are requesting a schooluniform grant. YEAR 7 STUDENTS ONLY i.e. transferring to the first year of secondary school in September 2014
Surname / First Name(s) / Date of BirthC Confirmation of Benefit
Please tick as appropriate and attach documentation confirming entitlement to benefit.
Income Support Income-based JSA Child Tax Credit (not Working Tax)
Guaranteed Pension Credit Employment & Support Allowance
Asylum Seeker Support – Please provide your NASS ref. number / /
D Declaration
I certify that the information given is correct to the best of my knowledge and belief. I have attached the required proof of qualifying benefit and supplied my National Insurance Number.
Your signature Date
Name of Child(ren) ______
E Receipt of the Grant
If your application is successful the uniform can be obtained directly through the School. Details of uniform included in this grant and further information will be available once approval has been given.
If you have any queries please contact the academy on 01542 713340 or email
For Office Use OnlyApproved: SUG number: ______/ Not Approved
Reason : Does not Qualify
Data checked :
Churchdown School Academy
Winston Road Churchdown Gloucester GL3 2RB
01452 713340 01452 857367
Head: Simon Packer Deputy Head: Sharon Hodgson
Assistant Heads: Leanna Arkell Bill Ballinger Stefan Horton Martyn Thomas
Business Manager: Shaun Lloyd