Financial Aid (Zakat) Application

Please complete this form. Submission of an application by an applicant (Recipient) does not constitute an obligation on ILIA to approve the form, and is contingent on availability of funds. This is to be used for non-refundable grants only.

Your Information

First Name

Last Name

Email Address

Confirm Email Address

Emails do not match.

Email Confirmation

Phone Number

Date of Birth

Address

Address Line 1

Address Line 2

City

Country

State

Provinces

State/Province

Postal Code

Obligations

Number of Dependents

Zakat/Grant

Amount Requested

How will this amount be used?

Explain in detail the situation, its root cause and your plans to recover. Explain how the grant will support your recovery plans

Please provide details on how this fund will positively impact your life, your dependents and the society around you

Provide full details with reasoning and possible outcomes

Please provide details in how the fund will lead to the development of the applicant's leadership skills and abilities

Please be as detailed as possible

Please provide breakdown of how funds shall be used, and provide full details of your income and expenses

You can provide this information in the form of an income sheet showing all income sources and amounts and all expenses per month - please be as detailed as possible

Please provide other alternatives that have been considered and the current status of each to alleviate the financial difficulty you are facing

Payee

Provide full details of the payee such as
Name, Address, Type, Phone contact, email address and a person's name. This information will be used to submit payments

Please add details for payee including address, account number, outstanding balance and mail a copy as indicated in signature question below

Documentation

Types of documentation needed shall vary from case to case. All cases require the following documentation to be uploaded.

Photo ID (Driver's license, passport, school ID)
Last year's tax return
Most recent 4 statements for bills from payee or equivalent
Proof of residence

Other pieces of documentation that are needed on a case by case basis are:

Income statements
Bank statement for past 90 days
Court orders, eviction notices
SSI and/or other government program eligibility letters

Please upload all items to this form.

Picture ID

Last year's tax return

Most recent 4 statements from payee or equivalent

Proof of residence

Other documentation

References

Please provide the following information for at least 2 references (Name, Address, Email, Phone, Relationship)

Reference 1

Reference 1 First Name

Reference 1 Last Name

Reference 1 Email Address

Reference 1 Phone Number

Reference 1 Relationship

Reference 2

Reference 2 First Name

Reference 2 Last Name

Reference 2 Email Address

Reference 2 Phone Number

Reference 2 Relationship

Reference 3

Reference 3 First Name

Reference 3 Last Name

Reference 3 Email Address

Reference 3 Phone Number

Reference 3 Relationship

Certification & Agreement

Applicant Sign Below. By signing, I certify that the information I submitted is accurate and truthful, and that I agree to the disclaimer, requirements and all terms and conditions in this form. I further agree to not hold ILIA, its board members, officers, employees, and agents and any donors funding this grant liable from any claims, demands of action I may have against ILIA as a result of omission, acceptance, rejection, suspension, or termination of my application. I further understand that even if I am eligible for support, I might no receive any assistance if funds are not available.

Sign Here

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