Expression of Interest Form

About Your School

For the following questions, please use/supply figures from your most recent census.

Country

Name of School

School URN/Seed Number

Local Authority

Date completed

Your First Name:

Your Last Name:

Your role:

Your email:

Head Teacher's First Name:

Head Teacher's Last Name:

Head Teacher's Email:

Breakfast provision leader's name (if applicable)

Breakfast provision leader's email (if applicable)

Address

Address Line 1

Address Line 2

Address Line 3

Town

County

Postcode

Phone Number

School Phase

School Type

If Academy, name of chain or MAT:

Number of pupils on roll (excl. nursery)

Number of nursery on roll (if applicable)

% Free School Meals (eligibility)

% Ever6 (% eligible for FSM in the last 6 years)

% Pupil Premium

% SIMD 1-4

% SIMD 1-2

Are there any particular challenges you are currently facing as a school?

	Tick all that apply
Ofsted
Education Scotland
Academy conversion
Budget deficit
Major staffing changes
Other

Other: please give details

Your Current Provision

Does a breakfast provision exist currently?

If yes, please provide details:

Start time:

End time:

Charge:

Unlimited free places?

No. of free of charge places currently:

No. of staff:

Use of catering staff?

Use of kitchen facilities?

How is it currently funded?

What food and drink is on offer daily at your breakfast provision?

How many children attend on a typical day?

What number of these are PP? (Please estimate if not sure)

What number of these are SIMD 1-4? (Please estimate if not sure)

Is that number capped?

Are there more children you would like to reach with breakfast? (Please comment.)

Are there particular challenges you are facing in delivering breakfast to those who most need it?

	Tick all that apply
Bringing in difficult to reach children
Engaging some families
Space or staffing for breakfast
Other

Other: please give details

Is there anything else you think it would be useful for us to know to support your application?