Zakah Fund Application
Amana Foundation
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Full Legal Name *
Mailing Address *
E-mail Address *
Primary Phone # *
Secondary Phone #
Marital Status *
Dependents (ages and relationship) *
Are you currently employed? *
If yes, state your monthly income:
Are you currently receiving any State or Federal Assistance? *
If yes, describe what type and amount:
Describe the situation and the need: *
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