Zakat Application

Disclaimer: All information provided are handled with confidentiality and applications are evaluated in an impartial and transparent manner and with the utmost objectivity.

Please read the following carefully before submitting. I accept and testify to the following

ICCR has permission to verify the information and documentation contained in this application from appropriate sources.
The information given on this application is true and complete to the best of my knowledge.
I acknowledge that I stand before Allah (swt) in truth and Allah is my witness.
If I knowingly give false or misleading information on this application I may be disqualified for requested assistance.

Legal Name

First Name

Last Name

Other name(s) you use

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Assistance

Food

Housing/Rent

Utilities

Medical

Education

Other

If "other" please describe

Reason for Assistance

Please provide detailed information to ensure the committee understands the need and responds appropriately.

Amount Requested

References

List the names and phone numbers of anyone with whom you are familiar with and can substantiate the information provided above.

Zakat Application

ISLAMIC CENTER OF CEDAR RAPIDS