Zakat Assistance

Applications from for the East Orlando area residents are the first priority.

To ensure the proper distribution of Zakat funds, every applicant must submit clear copies of the following:

Photo ID: For the applicant, spouse and all dependents; Driver’s License, State I.D. or Passport
Social Security Card (For all those that provided photo ID as identification.
Lease Agreement (If renting)
Proof of income (i.e. last pay stub)
Current tax return.
Other documentation that might help in the evaluation; such as medical reports, receipts, billing statements, etc.

All fields are required on this form except where noted “Optional”. All information is confidential and intended only for restricted internal use by authorized Zakat committee personnel and used exclusively for evaluation of Zakat requests.

Please attach/upload the scan/picture of the identification proof you will use.

For more information please contact the zakat committee by email only

Contact us: zakatInfo@aishacenter.com

Last name

First name

Application Date

Have you applied for Zakat assistance before?
YesNo

(If Yes) When?

Date Of Birth

Gender
MaleFemale

Place of Residence
OwnRentalRoom RentalShelterLow-Income HousingOther

Street Address

City

Zip Code

E-mail

Phone Primary

Alternate Phone (Optional)

Marital Status
SingleMarriedDivorced

Are you a "Citizen" or "Permanent Resident" or "Legal Resident" of U.S.?
YesNo

Select One Identification Proof
Driver's LicensePicture I.D.Passport .Enter the I.D. #

Upload your Picture ID

Number of Family numbers

Enter each name and age separated by comma below
(Including yourself)

Employment Status
Full TimePart TimeUnemployedSelf-Employed

Business Name

Business Phone Number

Expenses
Rent:$

Utilities:$

Other:$

Amount requested

Detailed reasons for requesting assistance (Please be specific)

REFERENCES: Please list at least 2 individuals-references who can confirm and verify the information you have provided on this application. References should not be immediate relatives, people who live with you or current zakat recipients.

Reference No. 1 - Name:

Phone:

Relationship:

Reference No. 2 - Name:

Phone:

Relationship:

Your message (optional)

Applicant Signature: (Enter Full Name)

Signed (Date):

I have read and understand the criteria for considering my application for zakat. (If YES, Please check box)

I hereby declare that the information provided is true and correct