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Home » Application to Beloveds In Need Fund

Application to Beloveds In Need Fund

Please complete the application, and we will be in touch with you within a few days about how we are able to help, inshallah. After we receive this application, we may contact you for additional information, and/or ask if we may speak to someone in your community who is familiar with your situation. The information on this form is secure and will be held in the strictest confidence.

"*" indicates required fields

Tell Us About Yourself

Have you taken the promise with Sidi or an authorized teacher?*

Yes

No

Have you taken shahada?*

Yes

No

Answering "no" does not disqualify you from receiving financial assistance.

Name*

First Sufi Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Secondary Phone

Email

Best Way to Contact You*

Second Best Way to Contact You*

Age*

Please Supply Contact Information For a Person Familiar With Your Situation

Contact Name*

First Sufi Last

Contact Phone*

Contact Email*

What is your relationship with this person?

Is this person familiar with your situation?*

Yes

No

Tell Us About Your Needs

Select all that apply

Your Needs*

Medical/Health

Shelter

Food

Clothing

Other

Status*

Veteran

Senior

Disabled

Single Parent

Homeless

Unemployed

Other

How Urgent Is Your Need?*

Immediate

Within 1 Week

Within 1 Month

Other

What kind of help do you need?*

Approximately how much money do you need to help with your current situation?*

Is there anything else about your situation you would like us to know?

Have you reached out to other resources? If so, what has been the result?*

Would you like us to hold you in prayer during this time? If so, what would you like us to pray for?

Your Income and Expenses

Total Monthly Income from All Sources*

Are you behind in any of your monthly payments? If so, by how much?*

Cost of Rent*

Cost of Utilities*

Cost of All Other Expenses*

List all Dependents, including Relationship and Age*

How to Send You Money

What is the best way to send you funds?

Zelle (takes 1 day, no fees)

Paypal (takes 1 day but may incur a fee)

Check (takes 3-5 days, no fees)

Who should we make a check out to?

First Last

Is your maling address the same as the address listed above?*

Yes

No

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Associated with Your Zelle or Paypal Account*

Email Associated with Your Zelle or Paypal Account*

Comments

This field is for validation purposes and should be left unchanged.

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