• PLEASE NOTE:
    1. Any information that is found to not be accurate will result in the rejection of the application
    2. Deadline for submitting the application is May 28th, 2019 at 6:00 pm. No applications will be accepted after that time
    3. Please submit a copy of picture IDs, copy of Social Security cards, and income verification documents (for all persons in household). Note: IDs must match current address.
    4. Application will not be processed until the required documents are submitted to the main office or social services office.
    5. WE ARE NOT RESPONSIBLE FOR SENSITIVE DOCUMENTS EMAILED TO US, THEY MUST BE SUBMITTED IN PERSON.

  • Date Format: MM slash DD slash YYYY
    Please identify visa type if applicable
  • Please enter a number from 0 to 50.
  • Full Name:Date of BirthRelationship 
    Including yourself
  • RentUtilities (Bills)FoodMedicalTransportation

  • By submitting this form, I acknowledge that the information above is correct to the best of my knowledge. I also affirm myself (and my household) to be eligible for Zakatul Fitr. I also understand that my application will not be processed until all the required documents are submitted in person to either the main office or social services office.