1. Any information that is found to not be accurate will result in the rejection of the application.
2. Deadline for submitting the application is May 28th, 2019 at 6:00 pm. No applications will be accepted after that time.
3. Please submit a copy of picture IDs, copy of Social Security cards, and income verification documents (for all persons in household). Note: IDs must match current address.
4. Application will not be processed until the required documents are submitted.
5. WE ARE NOT RESPONSIBLE FOR SENSITIVE DOCUMENTS EMAILED TO US, THEY MUST BE SUBMITTED IN PERSON.
6. ALL INFORMATION PROVIDED WILL REMAIN CONFIDENTIAL.
Head of Household First and last Name
Applicants First and Last Name
Country Of Origin
United StatesAfghanistanAngolaAlbaniaUnited Arab EmiratesArgentinaArmeniaAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaBelarusBelizeBermudaBoliviaBarbadosBrazilBrunei DarussalamBhutanBotswanaCentral African RepublicChileCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCosta RicaCubaCayman IslandsCyprusCzech RepublicDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaSpainEstoniaEthiopiaFinlandFijiMicronesia, Federated States ofGabonGeorgiaGhanaGuineaGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGuatemalaGuamGuyanaHong KongHondurasCroatiaHaitiHungaryIndiaIndonesiaIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJordanJapanKazakhstanKenyaKyrgyzstanCambodiaSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaMozambiqueMauritaniaMauritiusMalawiMalaysiaNamibiaNigerNigeriaNicaraguaNorwayNepalNew ZealandOmanPakistanPanamaPeruPhilippinesPapua New GuineaPolandPortugalParaguayPalestine, State ofQatarRomaniaRwandaSaudi ArabiaSudanSenegalSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSerbiaSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSeychellesSyrian Arab RepublicChadTogoThailandTajikistanTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUruguayUnited StatesUzbekistanSaint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, U.S.Viet NamYemenSouth Africa
Address* (Street Address)
Address Line 2
Legal Status* (US Citizen/Province/Region)
US CitizenLegal Resident (Green Card)Other
Please identify visa type / Other if applicable:
Are You Working?
If 'Yes' where do you work?
If 'No' are you receiving unemployment?
What's the last date of unemployment? (If receiving unemployment.)
Total Number of Family Members CURRENTLY residing in Household*
Please list ALL family members Residing in household: (Including yourself is required*)
Total Monthly Expenses*
Do you attend a local masjid?
Masjid Name and Imam?
Briefly explain, why are you in need for Zakat?
Documentation: Please include Identification and all papers that verify or are related to your situation. Lease/Eviction Notice, Hospital Letter(s), Termination Letter(s), Injury Report(s), Other Benefit Termination Letter(s) , Reference Letter(s).
Upload your files bellow(Upload file type: .doc/docx,.pdf)
Please list the name of two individuals that know your situation.
By submitting this form, I acknowledge that the information above is correct to the best of my knowledge. I also affirm myself (and my household) to be eligible for Zakatul Fitr. I also understand that my application will not be processed until all the required documents are submitted in person to either the main office or social services office.
I certify in front of Allah and the Believers that the above information is true and complete to the best of my knowledge. By typing your first and last name below will represent your electronic signature. It also means that you agree to the terms of Soulful Muslims Zakatul Fitr Application
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