Application for Financial Aid

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Please fill out the form fully and attach all the required documents in order for us to process your request. Incomplete documents will not be processed and delay your request. All information will be kept strictly confidential including any documents submitted.
This application can take up to 2 weeks to process after all the documentation has been received. The applicant’s signature certifies that all the information provided is true and complete.

Required Documents:

  • Copy of State ID or Passport
  • Copy of most recent Federal Income Tax Return
  • Copy of last 2 Pay-stubs
  • Copy of all Bank Account Statements (checking, savings & Investments)
  • Copy of Bills or other Statements for which this financial aid is being requested


Applicant’s information

Physical Ability

References

Please give names and telephone numbers of two Muslim individuals in the local community (not related to you) who know about your financial difficulties, and who have not received any aid or benefits from ICM SWC in the last 2 years:

Financial Information

Amount requested/Purpose/Financial Need

ICM Social and Welfare Committee processes checks to a third party. No checks will be written directly to the applicant. You must attach a lease contract, bills or other statements for which this financial aid is being requested.

Max file size is 10mb. Allowed file extensions are jpg, jpeg, png, gif, pdf. You cannot upload more than 4 files.

Document Upload

PLEASE UPLOAD THE FOLLOWING DOCUMENTS. YOUR APPLICATION WILL BE INCOMPLETE AND CANNOT BE PROCESSED WITHOUT THESE DOCUMENTS.
Please note that the below listed financial documents will be kept confidential/secured and will not be copied or reproduced.

Max file size is 10mb. Allowed file extensions are jpg, jpeg, png, gif, pdf.

Max file size is 10mb. Allowed file extensions are jpg, jpeg, png, gif, pdf.

Max file size is 10mb. Allowed file extensions are jpg, jpeg, png, gif, pdf. You cannot upload more than 2 files

Max file size is 10mb. Allowed file extensions are jpg, jpeg, png, gif, pdf. You cannot upload more than 4 files

Authorization

I certify that the information contained in this application is true. I authorize ICM's Social and Welfare Committee to investigate my needs and income including performing a credit check and obtaining my credit reports.