Financial Aid

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Financial Aid Request

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First Name

Last Name

Application Details Important Please completely fill and submit this form to request financial aid from IAA. Note: Due to overwhelming number of applications, currently, we are experiencing 2-3 weeks delay in processing applications. Only US Citizens and legal US residents are eligible For additional information or queries, please contact the IAA Financial Aid team at: iaafinancialaid@allenmasjid.com Jazak Allahu kahiran for your understanding.

Phone

Alt Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Any Contact Instructions?

Date of Birth

Do you live in USA?

Are you a US Citizen or Permanent Resident?

Official ID Information

Please make sure you upload these documents.

ID Number

This is the official document number

Martial Status

Please make sure you upload these documents.

Spouse Name

This is your spouse name.

Please explain if you have any permanent or temporary disability or serious illness?

Are you Zakat eligible?

Employment and Income Details

Note: IAA may contact your employer for verification

Job Status

Monthly Salary/Wagesc

Including tips and commissions

Total Monthly Household Income

Including Spouse's income, pension, social security, unemployment benefits, welfare, rental income, alimony etc.

History of Financial Aid

IAA would decline any application if the following questions are skipped or falsely answered. Answering "Yes" to any of these questions DOES NOT NECESSARILY DENY your application.

Have you or any of your dependents ever received any Financial Aid/Assistance from IAA?

In the last six months, have you or any of your dependents received any Financial Aid/Assistance or is currently receiving any Financial Aid/Assistance from any Government agency/department, any Masjid or organization other than IAA?

In the last six months, have you or any of your dependents been denied or declined any Financial Aid/Assistance request by any Government agency/department or any Masjid or organization?

Details of Financial Aid Needed

Please specify your financial needs. For utilities and rent, IAA issues checks to utility or rental companies/landlord ONLY and NOT in the name of the applicant.

Rent Amount ($)

Electricity Bill ($)

Gas (Heating) Bill ($)

Water Bill ($)

Phone Bill ($)

Other Expense Amount ($)

Other Expense Details

Additional Comments/Requests

Add brief description of your financial needs

Your References

IAA will contact your references for verification. References must be adult, non-family members with complete contact information.

Reference # 1

Include Name, Address and/or Contact Information:

Reference #1 Contact Number

Relationship to Reference #1

References must be adult, non-family members.

Reference # 2

Include Name, Address and/or Contact Information:

Reference #2 Contact Number

Relationship to Reference #2

References must be adult, non-family members.

Attachments *

Choose File

Upload any supporting documents. This may include copy of lease agreement, pay-stubs, utility bills and similar.

Preparer's Details

If you are preparing and submitting this application on behalf of someone else, please complete following details.

Preparer's Name

Preparer's Contact #

Preparer's Reasoning

Include brief description of why are you preparing this application on behalf of the beneficiary?

Declaration by Applicant

I grant the Islamic Association of Allen (IAA) permission to contact other masjids and organizations and my references for purposes of verifying and/or supplementing the information in this application. I understand that IAA may seek another local masjid/agency/organization’s cooperation in resolving my situation and that I may be asked to participate in programs (counseling, job training, education etc.) as a condition of any grant or assistance. I understand that if any information given turns out to be false or untrue, this application will automatically be denied..

I hereby render IAA as the official representative of the Zakat/Sadaqah funds that are released to me and give IAA’s Community Assistance Program (CAP) Committee authorization to make direct payments of my obligations on my behalf. I solemnly swear that the foregoing information is true and correct to the best of my knowledge, information and belief.

I agree and give IAA my full consent

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