General Application

Instructions: This form is to be completed by any organization or project seeking Zakat funding from the Zakat Fund of NYC. Any food related programs should use the separate Food Program Funding form.

Funding ApplicATION Form

Please email any attachments to info@zakatfundofnyc.org

Application Status

New Application

Renewal Application of Previously Approved Project by the Zakat Fund of NYC

Organization Name

Organization Phone

Organization Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Website

http://

Contact Name

First Name

Last Name

Contact Title

Contact Phone

Contact Email

Please provide the EIN for the organization.

Organizations must be registered 501(c)3 entities.

In general, please describe what your organization does and what services are offered to the community.

Please list all sources of funding/income (i.e. government, private, other) that organization receives for all projects. Please submit the 2 most recent Form 990. Include an audited financial statement, if available, with an auditors opinion and notes. If you do not have an audit, send an income statement, balance sheet, and annual budget.

Please indicate the size of your organization’s staff and whether it’s paid, volunteer, full or part time.

Please describe the specific project for which the organization is requesting zakat funds. How much funding is being requested from NYC Zakat? Are there other sources of funds that are supporting this project?

How many people / families will benefit from this project? Specifically, how much money is being requested per individual or per family in this project? Please breakdown the expected cost per person. If the organization is receiving funds for this project from other sources, please identify the shortfall in funds per individual / family or for the entire project.

Please provide a detailed breakdown of what the Zakat funds requested will be utilized for.

In what part of New York City is the organization located? What types of individuals will benefit from this project? How much is the total need in the community for this type assistance? If money was not a limitation, how many individuals could be helped by this project.

What is the demographic of your client base?

Please provide a list of your board members and their years of service. Generally our grantees are expected to have a board of at least five independent (i.e., not in the pay of your organization) members. If this is not the case, please elaborate.

By signing my name below and submitting, I understand that the application information provided on this form is true and accurate to the best of my knowledge and consent to use in connection with this request for Zakat.

Please be advised The New York Community Trust reviews all of our final grant recommendations and it may require additional information before a grant can be awarded. If this Application is approved, the Organization agrees to: 1. Provide NYC Zakat with a current financial statement every calendar quarter. 2. Maintain a system of receiving, processing and filing written applications from the individuals / families that receive benefits from the Zakat funds. 3. Send NYC Zakat quarterly progress reports (unless agreed to otherwise) listing how many individuals / families have received Zakat funds and the amount of money dispersed .

NOTICE OF CONFIDENTIALITY: This Zakat Form includes Confidential Information intended only for restricted, internal use by authorized personnel exclusively for evaluation of Zakat requests. Unauthorized use, copying, distribution or dissemination is strictly prohibited.