Application for Assistance — The Foundation for Local Needy

إِنَّمَا الصَّدَقَاتُ لِلْفُقَرَاءِ وَالْمَسَاكِينِ

"Charity is only for the poor and the needy…" — Qur'an 9:60

We serve the local community. The Foundation supports individuals and families living within 48 miles of Central Jersey. If you live farther away, you are still welcome to apply, although we may not be able to provide assistance.

This application helps us understand your circumstances so we can determine how best to provide meaningful support. It takes approximately 15–20 minutes to complete. Please have your identification, proof of income, and relevant bills or other supporting documents ready to upload in Section 7. Please answer all questions accurately and completely. Incomplete, insufficient, or inaccurate information or documentation may result in your application being denied.

You may move between sections using the buttons at the bottom of the page. Your information is saved only on your local device; the Foundation does not receive your application until you click the final “Submit” button. If you need to stop before completing the application, simply close your browser. When you return to the Foundation website, you will have the option to continue where you left off.

Section 1 — Application Instructions & Agreement

Assistance is offered to eligible individuals and families. Providing complete and truthful information, along with the required supporting documents, allows us to process your request without delay.

Yes, I agree to complete this application accurately and provide the required supporting documents. *

You must agree to continue.

Data Use & Privacy Authorization

By signing below, I voluntarily authorize The Foundation for Local Needy ("the Organization") to collect, store, use, and share my personal information solely for the purpose of evaluating and processing my request for charitable assistance.

1. Information Collected. This may include government-issued ID, Social Security Numbers, financial records, medical bills, eviction notices, and other documents relevant to my application, for myself and immediate family members. * 2. Sharing With Third Parties. I authorize the Organization to share relevant information — on a need-to-know basis only — with partner charitable organizations, mosques, and community members to verify my application and coordinate assistance. * 3. Confidentiality & Security. The Organization will treat my information as strictly confidential. All volunteers and staff are prohibited from discussing it beyond operational necessity. Reasonable security measures will be applied to protect against unauthorized access. * 4. Limitation of Liability. I release the Organization, its officers, volunteers, and contractors from liability for any unintentional data breach or unauthorized disclosure, to the extent permitted by applicable law, including the NJ Identity Theft Prevention Act and NJ Data Breach Notification Law. * 5. No Guarantee of Assistance. Signing this agreement does not guarantee I will receive assistance; it only authorizes collection and use of my information as described above. *

Please tick all five items to continue.

Application Review

The Foundation carefully reviews every application and conducts a thorough assessment before determining whether assistance can be provided. While we would like to help every person in need, our resources are limited and we cannot assist every applicant. May Allah سُبْحَانَهُ وَتَعَالَى relieve your difficulty and give you patience to cope with it.

All decisions made by the Foundation after reviewing an application are final and cannot be appealed.

Section 2 — Applicant Personal Information

Full Legal Name *

Exactly as it appears on your driver’s license or government-issued ID card.

Please enter your full legal name.

Date of Birth *

Please enter a date of birth in the past.

Gender *

Male Female

Please select one.

Mailing Address — Street *

Required.

Street Address Line 2

City *

Required.

State *

Required.

ZIP Code *

Required.

Primary Phone Number *

Required.

Email Address *

Please enter a valid email.

Marital Status *

Required.

Legal Status *

Required.

Legal Status — please specify *

For example: F1 (student), H1-B, B1/B2 (visitor), TPS, DACA, asylum pending, work permit.

Please specify your legal status.

Housing Type *

Own Home Apartment / Rental Shelter

Please select one.

Section 3 — Community Member Details

Please provide the name of the person who knows about your situation and the hardship you are going through. It is preferred that this person is not related to you.

Name *

Required.

Title / Role *

Required.

Masjid Name (if they attend one)

Phone *

Required.

Email

Section 4 — Employment History

Employment Status *

Employed Unemployed I have never worked

Please select one.

Last day of your last employment *

Please enter the date your last job ended.

Employer Name *

Current or previous, as applicable.

Required.

Job Description *

What you do, or did, day to day.

Required.

Salary *

Required.

Paid *

Required.

Section 5 — Household Dependents

Household Dependents *

One row per person. A new row appears as you fill the last one.

NameGenderAge Relationship

I have no dependents

Please list each dependent, or tick “I have no dependents”.

Section 6 — Explanation of Financial Need

Explanation of Hardship / Financial Need *

Required.

Household Income Sources *

Tick everything that applies and enter the amount. Give each amount as a monthly figure — not weekly or bi-weekly. If you have no income at all, tick “No Income”.

Total monthly income: $0

Tick at least one source and enter an amount for each one ticked, or tick “No Income”.

Monthly Expenses *

Tick everything that applies and enter the amount. Monthly figures again, please.

Total monthly expenses: $0

Tick at least one expense and enter an amount for each one ticked.

Requested Assistance Type *

Required.

Requested Assistance Amount ($) *

Required.

Have you ever applied for assistance from the Foundation? *

Yes No

Please select one.

Have you applied for Zakat/Sadaqah to the Foundation for this specific need, or any other need, in the past 6 months? *

Yes No

Please select one.

Please explain the outcome of that application. *

Please tell us what happened.

Has anyone in your household applied to the Foundation for this specific need, or any other need, in the past 6 months? *

Yes No

Please select one.

Please explain the outcome of that application. *

Please tell us what happened.

Have you, or anyone in your household, applied for Zakat/Sadaqah to any charity other than the Foundation for this specific need, or any other need, in the past 6 months? *

Yes No

Please select one.

Please give the name(s) of those organizations and the outcome of those applications. *

Please name the organization(s) and what happened.

Section 7 — Document Uploads

Accepted: PDF, JPG, PNG, HEIC, DOC, DOCX — about 25 MB per file. Each row is one document: say what it is, then attach it. Use + Add another for as many as you need.

Identification documents *

Driver’s licence, State ID, or passport. Start with yourself, then add a row for any other household member who has one. Only your own is required — children usually have none.

Please attach at least your own photo ID.

Social Security cards *

A clear photo or scan with the number readable. Add a row per household member who has one; only your own is required.

Please attach at least your own Social Security card.

Proof of income *

Please do not skip any source of income. Add one row per source, choosing what it is — the list matches Section 6.

Please attach at least one proof of income.

Proof of expenses *

Please do not skip any expense. Grocery and food receipts are not needed.

Please note these are your monthly expenses. Do not enter your debts here — debts have their own section below.

Please attach at least one proof of expense.

Debt documents

If you have any. Credit cards, loans, arrears, court judgements.

Any other documents

Anything else that supports your application.

Out-of-NJ Masjid reference letter (Imam / President / Board) *

Required because your address is outside New Jersey.

Required for applicants residing outside NJ.

Section 8 — Declaration & Signature

وَاللَّهُ مَعَ الصَّابِرِينَ

"…and Allah is with those who are patient." — Qur'an 8:46 (cf. 9:119)

I declare that the information provided in this application is true and complete to the best of my knowledge. I understand that any misrepresentation may result in the denial of assistance.

Type your Full Legal Name *

Please type your full legal name.

Signature *

Sign in the box below using your mouse or finger.

A signature is required.

Submission date and time are recorded automatically.