Financial Aid Request Form
Please fill this form completely and submit it to request financial aid from IAA. Only electronic forms are accepted, no physical copies of this form are available in the IAA Office.

NOTE:
• Only US Citizens and legal US residents are eligible for Financial Aid from IAA.
• Under exceptional circumstances others may be considered, however the beneficiary MUST be living in Texas (Dallas/Fort Worth Area)/USA legally.
• Any information declared in this application may be shared with other organizations or individuals.

For additional information or queries, please contact the EPIC Financial Aid team at: financial@allenmasjid.com

Do you live in the DFW metroplex?
Legal Name
Please write your legal name below. Do not abbreviate. Write with complete spellings.
First Name *
Your answer
Last Name *
Your answer
Contact Details
Primary Phone Number *
Your answer
Alternate Phone Number
Your answer
Email
Your answer
Street Address *
Your answer
Address Line 2
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Zip
Your answer
Country *
Please note that as per policy, individual financial aid is given to people living in TX (DFW), USA only.
Personal Information
Gender *
Date of Birth *
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Are you a US Citizen or a Permanent Resident of USA? *
Official ID Information *
ID Number *
Your answer
Marital Status *
Number of Dependents (Including Yourself) *
Please explain if you have any permanent or temporary disability or serious illness? *
Your answer
Employment and Income Details
IAA may contact your employer for verification
Employment Status *
Monthly Salary Wages *
Your answer
Total Monthly Household Income *
Your answer
IAA would decline any application if the following questions are skipped or falsely answered. Answering "Yes" to any of these questions DOES NOT NECESSARILY DENY your application.
Financial Aid
Including Spouse's income, pension, social security, unemployment benefits, welfare, rental income, alimony etc.
History of Financial Aid *
Yes
No
Have you or any of your dependents ever received any Financial Aid/Assistance from IAA?
In the last six months, have you or any of your dependents received any Financial Aid/Assistance or is currently receiving any Financial Aid/Assistance from any Government agency/department, any Masjid or organization other than IAA?
In the last six months, have you or any of your dependents been denied or declined any Financial Aid/Assistance request by any Government agency/department or any Masjid or organization?
Details of Financial Aid Needed *
Required
References
IAA may contact your references for verification
Reference #1 (Name, Address and/or Contact Information:) *
Your answer
Relationship to Reference #1 *
Your answer
Reference #2 (Name, Address and/or Contact Information:) *
Your answer
Relationship to Reference #2 *
Your answer
Select one of the following Options *
Affirmation and Consent
Affirmation and Consent"With Allah as my witness, I declare that the information being submitted in this Application Form is true to the best of my knowledge". Additionally, you certify that the funds will only be utilized for supporting basic personal needs as certified on the application and will not be utilized to violate any law. Further you certify that funds will not be utilized for :the financing of terrorism (18 U.S.C. § 2339C), or for providing material support or resources to terrorists (18 U.S.C. § 2339A), or to provide material support or resources to designated terrorist organizations (18 U.S.C. § 2339B). Islamic Association of Allen (IAA) tries best to keep discreet all the information disclosed in this online application. However, IAA, under certain situations, including but not limited to verification of your application, may share this information with others. By using this website, you acknowledge that you agree that Islamic Association of Allen (IAA) may collect, use and transfer your personal data and information with other individuals or organizations. *
Form Completion Date *
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