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Applicant Identity

IMPORTANT: This application is not for Fitrah. If you are applying for Fitrah, please apply under Fitrah Registration by clicking on link below.

https://epicmasjid.org/fitrah-registration/

Full Name *
Spell out full name exactly as it appears on your identity document. You will be asked to present a copy of identification document during application processing.

Email Address *
A valid email is required. Don't use email address of a family member or someone else.

Help Topic *

Application Details

Important

Applying for Fitra? click here

Please completely fill and submit this form to request financial aid from EPIC. A hard copy of this form can also be obtained from the EPIC Office.

Note:

Due to overwhelming number of applications, currently, we are experiencing 2-3 weeks delay in processing applications.

Only US Citizens and legal US residents are eligible

For additional information or queries, please contact the EPIC Financial Aid team at: financialaid@epicmasjid.org

Jazak Allahu kahiran for your understanding.

Contact and Personal Information

Phone Number *

Alternate Phone Number

Street Address *

Address Line 2

City *
Please note that as per policy, financial aid is given to people living in TX (DFW), USA only.

State *
Please note that as per policy, financial aid is given to people living in TX (DFW), USA only.

Zip Code *

Any Contact Instructions?
Other ways or any instructions regarding contacting you.

Gender *

Date of Birth *

Do you live in USA? *

Are you a US Citizen or Permanent Resident? *

Official ID Information *

ID Number *

Marital Status
Select all applicable

Spouse Name

Please explain if you have any permanent or temporary disability or serious illness?

Employment and Income Details

Note: EPIC may contact your employer for verification

Job Status *

Monthly Salary/Wages *
Including tips and commissions

Total Monthly Household Income *
Including Spouse's income, pension, social security, unemployment benefits, welfare, rental income, alimony etc.

History of Financial Aid

EPIC 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/Assistance from EPIC? *
Have you or any of your dependents ever received any Financial Aid/Assistance from EPIC?

Other Financial Aid/Assistance *
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 EPIC?

Financial Aid/Assistance Denials *
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

Please specify your financial needs. For utilities and rent, EPIC issues checks to utility or rental companies/landlord ONLY and NOT in the name of the applicant.

Rent Amount

Electricity Bill

Gas (Heating) Bill

Water Bill

Phone Bill

Other Expense Amount

Other Expense Details

Additional Comments/Request
Add brief description of you financial needs.

Your References

EPIC will contact your references for verification.
References must be adult, non-family members with complete contact information.

Reference # 1 *
Include Name, Address and/or Contact Information:

Reference #1 Contact Number *

Relationship to Reference #1 *
References must be adult, non-family members.

Reference # 2
Name, Address and/or Contact Information:

Reference #2 Contact Number

Relationship To Reference #2
References must be adult, non-family members.

Attachments
Upload any supporting documents. This may include copy of lease agreement, pay-stubs, utility bills and similar.

Drop files here or choose them

Preparer's Details

If you are preparing and submitting this application on behalf of someone else, please complete following details.

Preparer's Name

Preparer's Contact #
Ext:

Preparer Reasoning
Include brief description of why are you preparing this application on behalf of the beneficiary?

Declaration by Applicant:

I grant the East Plano Islamic Center (EPIC) permission to contact other masjids and organizations and my references for purposes of verifying and/or supplementing the information in this application. I understand that EPIC may seek another local masjid/agency/organization’s cooperation in resolving my situation and that I may be asked to participate in programs (counseling, job training, education etc.) as a condition of any grant or assistance. I understand that if any information given turns out to be false or untrue, this application will automatically be denied.

I hereby render EPIC as the official representative of the Zakat/Sadaqah funds that are released to me and give EPIC’s Financial Aid Committee authorization to make direct payments of my obligations on my behalf. I solemnly swear that the foregoing information is true and correct to the best of my knowledge, information and belief.

Consent *
I agree and give EPIC my full consent