Zakat & Sadaqah Application Form

Application is now open for residents of San Ramon and Contra Costa County. Only completed application with all requested documents will be evaluated

We will only evaluate zakat application once a month on the 25th of the month. Failure to provide all the requested information will have your application denied.
Name (Head of Household)

First NameLast Name
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
Name of Second Adult in Household

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I certify that I am a muslim and I qualify for zakat. I do not have assets worth more than $8000 locally or overseas :

YesNo
Please provide reference and contact: blank
Please provide reference and contact: blanks
Do you have state assistance?

Calfresh/CalworkSSI/Disability/EDDIHIS
Have you applied for assistance from other masjids or non-profit in the last 12 months.

yesno
Please list the organizations you have also applied for assistance from.
Please up a copy of 1) photo ID, 2) Lease agreements, 3) Cal Work Verification, 4) Bank Statements for the last three months. 5) Doctor's diagnosis if claming inability to work due to ill health. We will deny all applications without all the above supporting documents.

Cancelof
I am asking for assistance to the sum of $ blanks.
Requesting Information Regarding:
Upload your CV (if you need help looking for a job)

Cancelof
Should be Empty:

Application is now open for residents of San Ramon and Contra Costa County. Only completed application with all requested documents will be evaluated