Annual free school uniform initiative nomination form (2024)

Use this form to nominate families for free school uniforms from the Life House. To maximise each family’s chances of a successful nomination, we strongly recommend that you read the accompanying guidance notes. This year’s deadline for nominations is Friday 24th May.

§1: Nominator’s details
Name of organisation:	Click or tap here to enter text.
Name of referrer:	Click or tap here to enter text.
Position held:	Click or tap here to enter text.
E·mail address:	Click or tap here to enter text.
Telephone number:	Click or tap here to enter text.
Date of referral:	Click or tap to enter a date.

§ 2: Details of the family being nominated
Parent’s/legal guardian’s first name:	Click or tap here to enter text.
Surname:	Click or tap here to enter text.
Address and postcode:	Click or tap here to enter text.
Is this address safe for correspondence?	☐ Yes ☐ No
Telephone number:	Click or tap here to enter text.
Is this number safe for correspondence?	☐ Yes ☐ No
If it is not safe for us to use the address or telephone number, please suggest a safe means of communication:	Click or tap here to enter text.
Number of primary-school pupils who need uniforms:	Click or tap here to enter text.
Number of secondary-school pupils who need uniforms:	Click or tap here to enter text.
To the best of your knowledge, has anybody from this family been nominated to the Life House’s (formerly the Ark’s) free school uniform initiative in previous years?	☐ Yes ☐ No Your response here will not affect the nomination’s outcome.
Does this family, or a child in this family, have access to support under § 17 of the Childrens’ Act 1989? Does your organisation have any obligation to assist any member of this family with school uniform items? Your responses here will affect the nomination’s outcome.	☐ Yes ☐ Unsure ☐ No ☐ Yes ☐ No
If this family is unable to collect any uniforms that we may award, please explain why here so that we can make alternative arrangements with you.	Click or tap here to enter text.

§ 3: Reasons for nomination
Please tell us why the Life House should consider this family for its free school uniform initiative. (The guidance notes will help here!) Click or tap here to enter formattable text.

§ 5: Details of pupils included in this nomination – you’re welcome to include siblings who have the same legal guardian and attend different state-funded schools in Birmingham.
Name of child	School	Age in September 2024	Sex of uniform required
Click or tap here to enter text.	Click or tap here to enter text.	Choose an item.	☐ M ☐ F
Click or tap here to enter text.	Click or tap here to enter text.	Choose an item.	☐ M ☐ F
Click or tap here to enter text.	Click or tap here to enter text.	Choose an item.	☐ M ☐ F
Click or tap here to enter text.	Click or tap here to enter text.	Choose an item.	☐ M ☐ F
Click or tap here to enter text.	Click or tap here to enter text.	Choose an item.	☐ M ☐ F
Click or tap here to enter text.	Click or tap here to enter text.	Choose an item.	☐ M ☐ F
§ 4: Declaration
The information I have provided is accurate and true to the best of my knowledge. I agree that the Life House may use the contact details I have provided to discuss this nomination with me. I confirm that I wish to nominate this family for the Life House’s free school uniform initiative, and that I believe the family to be a suitable beneficiary. I know this family in a professional capacity; and am not personally related to any of its members. I confirm that the parent or guardian that I have named in this nomination has consented to his/her family being nominated for the Life House’s free school uniform initiative, and that he/she has legal parental responsibility for all the children for whom this nomination requests uniforms. I have explained the following information to the parent or guardian named in this nomination: The nomination might or might not be successful. If this nomination is successful, the Life House will make contact with the parent/guardian regarding uniform sizes and collection. The free school uniform initiative does not provide items such as footwear or pe kit. Unless a medical or safeguarding exemption applies, the parent or guardian is expected to collect (from Selly Oak) any uniforms that the Life House might award this family. By consenting to this nomination, the parent/guardian agrees that the Life House may use and store their data (in accordance with the Data Protection Acts 1988 and 2018) for these purposes: to decide whether to provide uniforms to his/her family; to communicate with the parent/guardian to enable us to give him/her the uniforms should the nomination be successful; and to identify any other areas in which the Life House may be able to help his/her family. Referrer’s signature: Please sign here; or, if you are submitting via work e·mail, type your name. Date: Click or tap to enter a date.

§ 6: Equal opportunities and monitoring data
Please complete this section as if you are the parent or guardian that you have named above. These questions are optional and do not affect the outcome of your nomination.
What is your ethnic group? Choose one option that best describes your ethnic group or background.
White ☐English/Welsh/Scottish/Northern Irish/British ☐Irish ☐Gypsy or Irish Traveller ☐Any other White background, please describe Click or tap here to enter text. Mixed/Multiple ethnic groups ☐White and Black Caribbean ☐White and Black African ☐White and Asian ☐Any other Mixed/Multiple ethnic background, please describe Click or tap here to enter text.	Asian/Asian British ☐Indian ☐Pakistani ☐Bangladeshi ☐Chinese ☐Any other Asian background, please describe Click or tap here to enter text. Black/African/Caribbean/Black British ☐African ☐Caribbean ☐Any other Black/African/Caribbean background, please describe Click or tap here to enter text. Other ethnic group ☐Arab ☐Any other ethnic group, please describe Click or tap here to enter text.
What is your religion?
☐No religion ☐Christian (including Church of England, Roman Catholic, Protestant and all other Christian denominations) ☐Buddhist ☐Hindu	☐Jewish ☐Muslim ☐Sikh ☐Any other religion, please describe Click or tap here to enter text.

For this section, we use the same questions, options and format as are used and recommended by the Office for National Statistics. We realise that this system is imperfect, but it allows us to analyse our data in comparison with official statistics, thereby helping us to improve our service with better insight. Thank you for your understanding!