Zakat Request Form

FINANCIAL ASSISTANCE APPLICATION

 

NOTICE OF CONFIDENTIALITY : This Zakat Form includes highly personal and confideantialInformation intended only for restricted, internal use by authorized personnel exclusively for evaluationof Zakat requests. Unauthorized use, copying, distribution or dissemination is strictly prohibited.

INSTRUCTIONS : Kindly help us to help those in need of Zakat. Please provide accurate and detailedinformation so we may evaluate Zakat requests in a timely and effective manner.

INCOMPLETE FORMS WILL NOT BE CONSIDERED.

Please bring the following documents with you to expedite your application for assistance:

  1. Photo ID – Mandatory
  2. Social Security Card – Mandatory
  3. Rent Receipt
  4. Any other bills, eviction notices, etc.

Section 1 : Applicant’s Information

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Section 2 : Applicant’s Circumstances

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Section 3 : Need Assessment (Approximate) and Prior Zakat Receipt History :

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Including: Alimony, Child Support, Social Security, Pension or others

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Including: Alimony, Child Support, Social Security, Pension or others

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Section 4 : Aid History:

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Section 5 : References :

List the names and phone numbers of anyone with whom you are familiar with, and can confirm the information you provided above.

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I testify in front of Allah (SWT) that the application information provided on this form is true and accurate to the best of my knowledge and I give consent to background checks regards confidential information to be released to MCC Rehab & Welfare Committee.

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By typing your name above you agree to accept this as your signature.

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