ZAKAT-UL-FITR APPLICATION

"*" indicates required fields

The following items are required to process your application

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

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.

Consent Date*