Financial Assistance Application (SRVIC)
Dear Community, Due to COVID-19 you may find yourself in need of assistance. Please do not hesitate to reach out to San Ramon Valley Islamic Center by submitting this application form.
For any questions with regards to this form, kindly email
Once completed, we will get back to you within 24 hours.

Please Note: By filling out this application, you are confirming that all information provided is true and accurate.
Any incomplete ,duplicate, or fraudulent applications will be disregarded completely.

Thank you
San Ramon Valley Islamic Center Management.
First Name *
Last Name *
Current Address *
Phone Number *
Email address *
Marital status *
Spouse First Name
Spouse last Name
Do you have children? If yes, how many? *
How many senior residents at this address? (65+)
Which Masjid do you most often attend?
Employment status (during COVID-19) *
Employment status (AFTER COVID-19) *
Monthly income BEFORE COVID-19 *
Do you need help with rent? *
Do you need help with groceries ? *
Do you need help with any other bills?
Estimate the $ amount you need
Comments: ( brief explanation of your situation. Please include dollar amounts for each payments due) *
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