Soulful Muslims Zakatul Fitr Application.

    PLEASE NOTE:

    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

    FIRST NAME* (Head of Household)
    LAST NAME* (Head of Household)

    Applicants First and Last Name

    FIRST NAME* (Applicant)
    LAST NAME* (Applicant)
    PHONE NUMBER* (Point of contact)
    Email* (Point of contact)

    Country Of Origin

    Address* (Street Address)

    Address Line 2

    City*
    State* (State/ Province/Region)
    Zip / Postal Code*
    Country*

    Marital Status*
    SingleMarriedDivorcedWidowedSeparated

    Legal Status* (US Citizen/Province/Region)
    US CitizenLegal Resident (Green Card)Other

    Please identify visa type / Other if applicable:

    Are You Working?
    YesNo

    If 'Yes' where do you work?

    If 'No' are you receiving unemployment?
    YesNoNot applicable

    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*)

    FIRST NAME* (Member 1)
    LAST NAME* (Member 1)
    Date of Birth* (Member 1)
    Relation* (Member 1)
    FIRST NAME (Member 2)
    LAST NAME (Member 2)
    Date of Birth (Member 2)
    Relation (Member 2)
    FIRST NAME (Member 3)
    LAST NAME (Member 3)
    Date of Birth (Member 3)
    Relation (Member 3)
    FIRST NAME (Member 4)
    LAST NAME (Member 4)
    Date of Birth (Member 4)
    Relation (Member 4)
    FIRST NAME (Member 5)
    LAST NAME (Member 5)
    Date of Birth (Member 5)
    Relation (Member 5)

    Additional Members

    Monthly Income*
    Government Assistance*
    Private Institution Assistance*

    Total Monthly Expenses*

    Rent*
    Utilities*
    Food*
    Medical*
    Transportation*

    Do you attend a local masjid?
    YesNo

    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.

    Name (Individual 1)
    Phone (Individual 1)
    Email (Individual 1)
    Name (Individual 2)
    Phone (Individual 2)
    Email (Individual 2)

    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.

    Signature: