ZAKAT-UL-FITR APPLICATION

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The following items are required to process your application

One Application Per Household
Applicants will not be contacted if your application is denied
All sections of this form must be completed
Attach a copy of Driver's license or State-issued photo ID card with current address that matched the address listed below. If the current address is not updated on Driver's license, please provide valid proof of address.
Attach a copy of your latest Tax return if available
Attach a copy of Free or Reduced Lunch letters for school aged children. In case if the child does not have a lunch letter, please provide his/her health insurance cards of school IDs.

Application Date*

Driver's License*

Name (Head of Household)*

Birth Date*

Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you a citizen of the United States?*

YES

If "NO", what is your immigration status?

Total Monthly Income of all persons living in the Household:*

Expenses

Rent*

Phone*

Utilities*

Auto & Transportation*

Other Expenses

Number of Family Members*

Details of Family Members*

Name

Age

Income (If Any)

list other additional members of the household that work, their age and their income - for anyone 16 years old and over.

Please specify if you have applied for Zaket-ul-Fitr at any other organization*

Please attach form files

Driver's License OR State Issued Photo ID Card

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Valid Proof of Address (If applicable)

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Latest Copy of Tax return (if available)

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Free or Reduced Lunch letters for school aged children OR Health Insurance cards of school IDs

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Signature*

Consent Date*