ICS Means Testing Declaration Form ***IMPORTANT: PLEASE READ CAREFULLY***

International Citizen Service (ICS) will be largely funded by the Government but those who can afford to will be required to make a financial contribution depending on their income level. This is to help ensure that a wide spectrum of people from all backgrounds can participate.

In order to confirm your income status and finalise your contribution level we need you to declare your household income and sign this declaration form.It is extremely important you find out all the information needed to select the category that honestly and accurately reflects your total household income. We will be spot checking participants to validate if the information is correct. If you are found to be dishonest in your answer you will be immediately dismissed from the programme and any future ICS programmes.

First you need to decide what category you fit into below (a or b), and then calculate the total household income on which you depend.

  1. You are financially dependent on parents / carers in some way (i.e. you rely on their income to fully or partially support you – this could be small or large amounts of support and includes things such as rent, pocket money, payment of your bills or student fees etc). To work out your household income you need toadd together your parents’ / carers’ total pre-tax income for the last tax year as well as your own pre-tax income if you have any. The total figure is what you must declare below. Even if you only receive a small amount of support from your parent / carer, you must include their income when working out the total. Many people will fit into this category – the most common are those living at home and not paying rent / household expenses or those studying / working away from home but getting support while theydo it.
  2. You are financially independent(ie. you only survive on the income you earn and do not get any financial support from anyone else). The household income figure you must declare below isyour own pre-tax income for the last tax year. Most people in this category will be full time workers living away from home.

Contribution levels are as follows:

Tier 1: Household income over £40,000 per year£2,000

Tier 2: Household income between £25,000-£40,000 per year£1,000

Tier 3: Household income less than £25,000 per year£0

Declaration

Is the income of the household on which you depend:(Please tick the box which applies to you)

[ ] over £40,000 per year

[ ] between £25,000-£40,000 per year

[ ] less than £25,000 per year

[ ] I declare that all the income related information I have provided on this form is true and correct. Where I am dependent on my parent / carer, they also confirm that this information is true and correct.

[ ] I (and my parent / carer where I am financially dependent on them) acknowledge that further checks may be carried out to ensure the validity of the income information and undertake to provide proof of my / our household income if required to do so.*

* If requested to do so, you will need to provide your and / or your parents’ / carers’ P60 and / or Self-Assessment tax return if any of you were self-employed for the last tax year. If you are on benefits, you will need to provide your and / or your parents’ / carers’ latest letter of entitlement to benefits or other proof as requested of the benefits you receive.

Signed: ______Date:______
(Participant)

Signed: ______Date:______
(Parent/Carer if you are financially dependent on them)