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Al Maun Fund

Application Form

List is reopened of May 12, 2013


  • You must reside in the United States to apply
  • Non US residents will not receive a reponse to any submission
  • You must answer all questions. Please put "o", none or "n/a" if a question does not apply to you.
  • A staff member will be in contact with you within 5-7 business days from date of application
  • You application has been successfully submitted if you see a reply in green that says the application has been sent successfully and you no longer see the application. If not, scroll not for any questions in red you may have overlooked.

 

First Name:
Last Name:
Are you related to anyone working with Al Maun Fund?
How did you hear about us?
Have you ever applied with us before?
When?
Gender
Date of Birth
Marital Status
Last 4 digits of social security number
Please provide your street address, apt number, city, state and zip
Phone Number
Alternative Phone Number
What is your email address?
What race or ethnicity best describes you?
How many children are living in your home?
List all names, relation to applicant, ages, date of births,and genders of children in home
List names of all other household members if any
What services are you in need of?
Please explain in detail the circumstances of your need
What is the monetary amount you are in need of?
What is your source of income?
How much is your family's annual income
Do you receive spousal support, child support,
or any other unearned income? If so, how much monthly and source
Do you or family members receive food stamps? If so, how much per month?
Does anyone in your household have a medical or physical disability? Please explain
Are you able to provide written proof of the above existing medical condition?
Please provide at least one reference. Include their name, address, email and phone
Do you understand that by submitting this form you are granting permission for us to verify by phone, fax, email, letter or other then that, all information submitted & related to handling your request?
Do you understand that you must provide documentation that verifies your identity, residence, source of income, housing costs, and related items that substaniates your requested expense? (such as picture ID, paystubs or unemployment, bank statement, lease or mortgage book, award letter for SSI, Disability or Food stamps etc?)
Do you have access to a fax or scanner by which to submit your documents?
Do you understand that you will be given a maximum time span of (5) business days to submit your paperwork from date of your phone interview?
Do you understand that before we can determine what can be dispersed that you must supply all requested verifications?
Do you understand that funds/services/items are not guaranteed?
Do you understand that Al Maun Fund can only fill one qualified request per applicant per year? (depending on fund availability)
You must agree to a direct payment to payee ie. business/service provider
Please share any addtional comments
Please type in your full legal name. By typing in your name you are declaring that all information included is true to the best of your ability and that you will supply all requested paperwork to evaluate your request.