Need Financial Help

Need Financial Assistance?

We’re Here to Help Reach Out with Confidence and Privacy

Muslim Association of the Carolinas / Masjid Al-Madina – Raeford, NC This application is intended for individuals or families seeking temporary financial assistance due to unforeseen hardships such as job loss, difficulty covering rent or utility bills, or educational expenses. The Muslim Association of the Carolinas is dedicated to supporting our community during challenging times. We ask that you complete this form with honest and accurate information to help us process your request efficiently and fairly. Please remember that any assistance provided comes from the donations and trust of fellow Muslims, and must not be misused or requested under false pretenses. May Allah (SWT) ease your difficulties, grant you relief, and fulfill your needs. Ameen.

Confidentiality Statement

The information provided in this application will be used exclusively to assess the financial assistance needs of the applicant. We are fully committed to maintaining your privacy, and all personal details will be handled with the highest level of confidentiality. Your information will not be shared with anyone outside the Muslim Association of the Carolinas unless you provide explicit written consent or as required by law.

Who Should Fill This Form:

1. Muslim residents of North Carolina who are facing financial hardships.
2. Individuals who require immediate assistance for essential needs like housing, utilities, education, or medical expenses.
3. Applicants who are seeking one-time or short-term financial support.

Application For Financial Assistance

Section 1

Personal Information

Full Name

Date of Birth

Gender

Marital Status

Address

Street

City

State

Zip Code

Email Address

Phone Number

Which area masjid do you attend regularly?

Section 2

Family and Household Information

Total Number of People in Household:

Names and Ages of Household Members:

Section 3

Employment and Financial Status

Current Employment Status: (Choose one)

Employer Name (if applicable):

Other source(s) of Income or financial assistance: (Choose one or more)

Section 4

Reason for Assistance Request

What is the primary reason for seeking financial assistance?

Amount of Assistance Needed:

Purpose of Financial Assistance:

How long do you anticipate needing this assistance?

Section 5

Supporting Documentation and References

Please take a picture and upload any supporting documents:

1. Recent Pay Stubs
2. Bank Statements
3. Lease Agreements
4. Utility Bills
5. Medical Bills
6. Any other relevant documents

Image must be in JPG format and should not exceed 20 MB in size

Upload Image

Do you have anyone who is familiar with your financial situation and can be contacted?

Section 6

Declaration and Agreement

Please read the following statements before signing this application

I hereby declare that the information provided in this application is true and complete to the best of my knowledge.

I understand that any false information may result in the denial of my application.

I also declare that I have not applied to any other masjid for financial assistance in the last 1-6 months.

I agree to the terms and conditions

Section 7

Signature

Applicant's Signature: (Image must be in JPG format and should not exceed 20 MB in size)

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Date

Masjid Al Madina Raeford, NC