Part A: Eligibility Form- school confirmation
Part A: should be completed by a member of staff at your school (either
current or school you attended before you were 16). They must be able to confirm your eligibility for an SMF
programme.
Part B: should be completed by your parents or legal guardians to give consent applying to the programme
(s). You must complete the relevant part B form.
Please complete part A and the relevant part B (s) in block capitals and send this in by Friday 9th January
2015.
Both parts must be sent in to the ‘Social Mobility Foundation, 1st and 2nd Floor, 43-47 Leadenhall Market,
London EC3V 1LR’ Please write above the address on the envelope the programme(s) you’re applying for.
Name of programme(s) applied to: ____________________________________________________
City: ____________________________________________________
Name of student (full name): ____________________________________________________
Please tick at least one of the following:
◻ I can confirm that this student received, or would have been eligible to receive Free School Meals (i.e. household
income less than £16,190 if in England/Wales/Northern Ireland or £15, 860 if in Scotland).
and/or
If they attend school in London:
◻ I can confirm that this student currently attends, or previously attended for their GCSEs, a school/college with
30% or more of its students eligible to receive Free School Meals AND that this student will be the first generation in
their family to attend university in the UK.
If they attend school outside of London:
◻ I can confirm that this student currently attends, or previously attended for their GCSEs, a school/college with
20% or more of its students eligible to receive Free School Meals AND that this student will be the first generation in
their family to attend university in the UK.
School stamp:
Signed ___________________________________________________________ (SCHOOL STAFF MEMBER)
Print name ________________________________________
Position __________________________________________
_______________________________
Date