almaunfund.org - Sadaqa Request Form

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IMPORTANT>>If you do not see this "Thank you for contacting us, inshaallah someone will reply to you within 72 hours" after pressing the submit button, then we have NOT received your request. Please scroll down,look for error messages and fix mistakes
IMPORTANT As of 03.01.07 All requests are limited to once every (6) months per family. (No matter what the amount received during previous filled requests) Priority is given to those who have never been helped by fund before, and also needs of urgency, such as medical needs and janazahs & emergency food.
Please fill out form truthfully, accurately and completely.
Once request is received, you will be contacted within 1-2 days insha'allah. If there is is some urgency to your situation, please note that in comments.
Monies are dispersed as they are received, therefore we cannot quarantee assistance.
Please note that we can only attempt to help each request with $200.00 or less, starting 4/01/2005. (again funds based on availibility)
However if you need more then that ($200.00), still feel free to fill out form below, we can see what other resources we can locate on your behalf.
We are always in need of sadaqah and/or zakat. Please make a donation
If you are in need of clothing or others goods, take a look at our free items page.
Please be assured all information remains confidential.
You must provide a valid email address, and it is your responsibilty to respond to emails or phone calls placed to process your request.
Please know that we verify requests for financial assistance.
Please know that you must submit verification of need within the time we specifiy once we speak with you in order to receive funding.
This form is for both financial assistance, utility help, food needs and clothing needs (which includes the free goods page)

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Sadaqa Request Form

Today's Date *
Name *		Your full name (include full legal name & kunya)
Email *
Date of Birth *
Are you Muslim? *	yesno
Are you Male or Female? *	MaleFemale
Residence Info *		Please provide your street address, apt number, city, state and zip
Phone Number *	xxx-xxx-xxxx
Alternative Number *		Any alternate phone #, work, cellphone, family
Are you married? *	yesno
Are you Employed? *	yesno
Is so, who is employer?
How did you hear about us? *
Have you received from this fund before? *	yesno
If so for what?
What is your need? *
What is the monetary amount you are in need of? *
Please share more details regarding your situation *
Grant permission to verify request *	yesno	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
Agree to time required to submit documentation: *	yesno	Do you understand that if we allot funds/services/items on your behalf you will have 3 days to accept and supply requested verifications?
Do you understand that funds are not guaranteed? *	yesno
Do you agree to direct payment? *	yesno	You must agree to a direct payment to payee ie. business/service provider.
Can you provide references & documentation of need *	yesno	Specific items as requested upon review of case
Please provide a reference *		Please provide name, phone # and/or email address of someone who can verify your need
Have you sought assistance anywhere else? *	yesno
If so, what is the name of the contact person?
Are there any pending monies from this source?	yesno
What Masjid do you attend? *
What is the Masjid's phone number
Have you already contacted them for assistance? *	yesno
Have they already provided help with this request?	yesno
Do you have children?	yesno
If so how many and what are their ages?
Please note here if you or another family member is in need of clothing.		If you are requesting clothing, please include gender, height and sizes for all family members in need
Are you filling out this form for someone else?		If so, please list your name, email and phone #
Additional Comments

Please fill out form truthfully, accurately and completely.

Once request is received, you will be contacted within 1-2 days insha'allah. If there is is some urgency to your situation, please note that in comments.

Monies are dispersed as they are received, therefore we cannot quarantee assistance.

Please note that we can only attempt to help each request with $200.00 or less, starting 4/01/2005. (again funds based on availibility)

However if you need more then that ($200.00), still feel free to fill out form below, we can see what other resources we can locate on your behalf.

We are always in need of sadaqah and/or zakat. Please make a donation

If you are in need of clothing or others goods, take a look at our free items page.

Please be assured all information remains confidential.

You must provide a valid email address, and it is your responsibilty to respond to emails or phone calls placed to process your request.

Please know that we verify requests for financial assistance.

Please know that you must submit verification of need within the time we specifiy once we speak with you in order to receive funding.

This form is for both financial assistance, utility help, food needs and clothing needs (which includes the free goods page)