Please Type your full name as signature of this application
1. I understand that Dar al-Hijrah may refer my case to County Agencies and Centers first.
2. I understand that it may take a minimum of 10 days and a maximum of two weeks to process my
3. I understand that I can give back to the community by volunteering some of my time whenever it is
convenient for me, however, I am not obligated to do so.
4. I understand that regardless of whether my application is approved or denied, I agree that Dar al-Hijrah
can keep copies of my documentations, those pertaining to my file.
5. I understand that I may be subject to a home visit by a social worker.
6. Dar al-Hijrah has the right to deny any case without any explanation.
7. The social workers will collect the application information and documents to assess my current
situation. They may verify the information by calling my references and/or other caseworkers, or any
8. I acknowledge that the information that I have provided is correct.
9. Dar al-Hijrah has my permission to anonymously describe the circumstances of my case to secure
10. I understand that my application will NOT be processed until after submission of all applicable documentation that is needed.*
11. By signing this application, I testify that I am not involved in any activities that would be characterized as terrorist activities. I also do not support or have any connections with individuals or organizations
affiliated with terrorist activities.
*Note: Please submit all the required documents to either the main office at Dar Al-Hijrah or the social services office.
2. WAIVER & RELEASE: By submitting your Zakah application to this Masjid, you agree to having your name, phone number, mailing address, email address, and/or your skill/talent identification shared with other Masjids within the Washington, D.C., Maryland, and Northern Virginia metropolitan area. This information is shared to prevent fraud and to improve Zakah services. This Masjid will never sell your personal information.
You agree to hold this Masjid harmless for any liability arising from this Masjid's secure disclosure of the above mentioned information to other Masjids. You also agree to waive any rights or expectations of privacy in the above mentioned information with regards to this Masjid and your Zakah application.
Except as required by local, state, or federal laws, your social security number, driver's license number, and other supporting documentation that you submitted with your Zakah application will not be shared.