Education Assistance

This form is to be used for submitting applications for Education Financial Assistance

Quba Center
22149 Davis Drive, Suite 180, Sterling VA 20164
(703) 552-1243
socialservices@quba-center.org
Quba Center is a Registered 501(c)(3), Tax ID 83-0626326.

PLEASE READ BEFORE FILLING OUT THE FORM
1. You must be Zakat eligible to apply for financial assistance.
2. Time Required: The form will take approximately 30 to 45 minutes to fill out - please ensure you have this amount of time before filling out.
3. You will need the following documents (mandatory) before applying:
  
  - Unexpired photo ID (State-issued ID, Driver's license, or Passport)
  - Proof of citizenship or proof or lawful residency (USA Passport, Green Card, Work Permit, or Visa)
  - Most-recent tax return.
  - Two most-recent bank statements.
  - Lease or mortgage agreement or letter from property owner indicating that you are living there.
  - Utility bills (Gas, Electricity, Trash).
  - Credit Card statements.
  - Pay statements (if you are employed).
4. Process: Once we receive this form along with the submitted documents, the Quba Social Services team will review the information and assign a case worker. The case worker will contact you through email to inquire about additional information that may be needed. The application processing time is approximately 30 days from the date of submission, provided all necessary information is complete and submitted.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
Please provide a valid email address, as it will be used for correspondence related to this submission.
Phone Number*

Area CodePhone Number
Date of Birth*

YearMonthDay
Date
US CitizenPermanent Resident (Green Card)RefugeeAsylum Seeker
SingleMarriedWidowedDivorcedSeparated
Spouse Full Name*

First NameLast Name
Spouse Date of Birth*

YearMonthDay
Date
YesNo
Spouse Address (Street, City, State, Zip)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Employer*
Spouse Monthly Wages?*
YesNo
How many additional people are in your household?*
Don't include yourself or your spouse.
How much income/month do these additional members make together?*
Don't include yourself or your spouse.
Preschool Full DayPreschool Half DayPre-K Full DayPre-K Half DayKGGrade 1Grade 2Quran After school ProgramWeekend Program - Sunday onlyOther
How much amount is needed?*
Please explain your situation and why you need this assistance*

0/500
YesNo
Employer Name (Enter most recent if currently unemployed)*
What are your Monthly Wages?*
Which Islamic Community Center or Masjid do you attend?*
YesNo
Additional Monthly Gross Income

Enter 0 if None
Section 8 (housing)
Child Support
Food Stamps (EBT)
TANF
Charity Organization
Family Assistance
Monthly Expenses

Enter 0 if None
Rent / Mortgage*
Utilities*
Phone / Mobile Phone*
Transportation*
Car Payments + Insurance*
Food*
Family Assistance
Assets

Enter 0 if None
Property Equity
Other
Required Documents
Recent Tax Return2 Most Recent Bank StatementsLast 2 Pay StubsUnemployment Letter and Unemployment Subs (if applicable)Public and Other Assistance (TANF, EBT, Section 8, Child Support, Other)
2 Most Recent Bank Statements (highlighted Bills, Expenses)Current Lease / Mortgage StatementRecent Utility BillsCar Payment + Insurance BillsRecent Credit Card Statement
Please upload a valid, unexpired photo ID (State-issued ID, Driver's License, or Passport)*

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Please upload your unexpired proof of citizenship or proof or lawful residency (USA passport, Green Card, Work Permit, or Visa)*

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Please upload your most-recent tax return

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Please upload your two most-recent bank statements*

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Please upload your two most-recent pay stubs

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Please upload your current lease/mortgage agreement, or a letter from the property owner*

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Please upload your most-recent utility bills (Gas, Electricity, Water, Trash)*

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Please upload your unemployment letter and unemployment subs, if applicable

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Please upload documentation for public and other assistance programs (TANF, EBT, Section 8, Child Support, Other), if applicable

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Please upload your car payment and insurance bills, if applicable

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Please upload any other supporting documents, if applicable

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Authorization and Signature
I authorize Quba Center to collect and store all information entered on this form.Quba Center has permission to verify information provided by in this application as appropriate.I have provided true and complete information to the best of my knowledge and I understand that this application may be disqualified if I knowingly provided false information on this application.Applicant acknowledges that he/she stand before Allah (SWT) in truth and Allah (SWT) is his/her witness. “O you who believe! Fear Allah (SWT) and be with those who are true (in words and deeds).” (9:119)Quba Center has the right to deny any case without any explanation.I understand that regardless of whether my application is approved or denied, I agree that Quba Center can keep copies of my documentations, those pertaining to my file.I understand that it may take a minimum of 14 days and a maximum of three weeks to process my application.Quba Center has my permission to anonymously describe the circumstances of my case to secure funding.
Signature*

Clear
Please verify that you are human*
Should be Empty:

Additional Monthly Gross Income

Monthly Expenses

Assets

Required Documents

Authorization and Signature