Application for Financial Assistance
( Please read the1notes before filling the application form and complete all sections with 
block capital letters  and you may use additional sheet/s if  the space provided is not enough.)

Please
affix  your
recent
photograph
here

Forename	
__________________________________________________________________________	

Surname	
__________________________________________________________________________		

Date of Birth: 
	
Country of Birth: 	
Nationality  	
Country of Residence:_______________	
Sex:                    Male     Female	Marital Status:                       Single    Married	 Number of  Children   	 	
 
Permanent Address		 
Temporary Address	

Address: 		
Address	
			
City: 	                                                   Post Code: 		City:	                                                Post Code	
Country:			Country:		
Tel: 	                                                  e-mail:		Tel:	                                              e-mail	

Details of Parents’ Employment 		
Other Sources of Income	
Income	Father	Mother		Income	Father	Mother	
	Amount	Amount			Amount	Amount	
 Employed				 Dividends			
 Self Employed				 Investment/Savings		                    	
 Directorships				 Child/ren Income			
  Other (specify)				 Other (specify)			

Employment Details 		
Other Sources of Income	
Income	Self	Spouse		Income	Self	Spouse	
	Amount	Amount			Amount	Amount	
 Employed				 Dividends			
 Self Employed				 Investment/Savings			
 Directorships				 Child/ren Income			
  Other (specify)				 Other (specify)			

Are you entitled to receive Loan or funding/scholarships from the Government or other Institutions?	  Yes      No

If you have answered   Yes, please state the amount you have or expect to receive from this source.	Amount________________________

Course Details
Course Title	Name of Certificate/Degree	College/University	Duration	Country	Start Date	

Reasons for Choosing the Course :	
………………………………………………………………………………………………………..………………….
………………………………………………………………………………………………………..………………….
………………………………………………………………………………………………………..………………….	
If asked by the trustees would you  change the Course ?         Yes      No           
If yes,  what are other courses you might do?         ____________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________________

What are your future plans after completion of the course?  _____________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________	

Educational Achievements To-date
School/College/University	Certificate/Degree	Subjects	Grades	Country	Date passed   	

						

Details of Financial  Support Required
	Currency:     Local      US$ Dollars      UK £ Sterling	Amount	
  Course Fees	Amount: …………	 Monthly      Yearly        Only Once		
  Living Expenses	Amount : …………	 Monthly      Yearly        Only Once		
  Medical Insurance	Amount : …………	 Monthly      Yearly        Only Once		
  Other Expenses	Amount : …………	 Monthly      Yearly        Only Once		

Past History of Funding
Organisations’ Names who supported you  in the past?	Type of Support:    Fees     Living Expenses     Medical Insurance      Other 	
Organisation	Country	Date	Support	Amount	
			1    2    3    4		
			1    2    3    4		

Please give reasons why these Organisations have stopped supporting you. ____________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________	

Funding from other Organisations

Which other Organisations you have applied for support ?	Type of Support:    Fees     Living Expenses     Medical Insurance      Other 	
Organisation	Country	Date applied	Support	Decision	
			1    2    3    4	  Accepted     Refused     Pending	
			1    2    3    4	  Accepted     Refused     Pending	
			1    2    3    4	  Accepted     Refused     Pending	
 If your application is successful, please indicate the exact amount of financial  support you expect from  each of these Organisations.	Amount	

College/University’s Name & Address: …………………………………………………………………………………………………………………………...

…………………………………………………………………………………………………………………………...………………………………………… 

Contact Name:………………………… ……………………  Telephone No:……………… ………………………  e-mail address:……… ………………..

Referees
Please give below the details of two officials of an internationally reputable Islamic Organisations whom you have known personally and at your request will provide with their recommendation letters in support of your application..

Organisation’s Name:	Organisation’s Name:	
Nature of work:	Nature of work:	
Referee’s Name:	Referee’s Name:	
Position in the Organisation:	Position in the Organisation:	
Full Address:	Full Address:	
		
Tel:                                                 Fax:	Tel:                                                 Fax:	
Email :	Email :	

Bankers
Personal 		College/University 	

Bank’s Name &  Address:………………………………………………. .…………………………………………..………..……………………..		
Bank’s Name &  Address……………………………………………….:  .…………………………………………..…………….………………..	
………………………………………………………………..…….…...		………………………………………………………………..…….…..…	

Account Name:	
………………………………………………….….		
Account Name:	
………………………………………………….….	

Account No:	
……………………………………………………..		
Account No:	
………………………………………………….….	

Sort Code:	
…………… Branch Name:……………………….
 ………..……………………………………………		
Sort Code:	
…………… Branch Name:………………………. 
 ………..……………………………………………	

Declaration

I bear Allah Subhanahu Wa Taala as my witness and declare that the information I have provided in this application is true and correct to the best of my knowledge and belief.   I confirm that I have not yet received any grant or scholarship for the same purpose from any other source or organisation.  I hereby undertake to inform the Charity immediately in case my financial circumstances improve or receive financial assistance from another organisation. I understand that any misstatement in my application will result in rejection of my application and shall be liable to refund the full amount of any funds I received till the date of discovery of inaccuracy in my application. 	

Name : ……………………………………	
Signature: …………………………………………	
Date : ………………………………………	

IMPORTANT NOTES
Please  enclose all the required documents with your application. Failure to do so will delay the processing of your application and may also result in refusal. Acknowledging  of an application is not an  indication that the financial assistance will be provided by the Charity. Please provide us with documentary evidence if your parents are unable to contribute towards your course fee.	

References & Supporting Documents
Please provide the following documents:

•	Original recommendations letters are to be sent direct to our Charity from two referees from the officials of two independent reputable Islamic Organisations  who know you personally.
•	One letter of recommendation from a person who is well acquainted with your academic qualification and who could vouch your suitability of choice for the intended course (lecturer, teacher or tutor.)
•	A letter/s from the college/university confirming the following:
A.	date of enrolment, expected date of completion, tuition fees payable, living expenses and college/university’s bank details (tuition fees are usually paid directly to the college or university). 
B.	Copies of your own and parents’ bank statements relating to all current and savings accounts for the last six months.  Please remember to give full details of your own bank account on application form..
•	A copy of passport or ID card with two photographs recently taken.  Proof income. Copies of certificates awarded by  the School/ College/university.	

For Office Use	
App. Ref. No.	
Date Received:        /        /   	
Checked By: …………………	

Application Form            Complete            Incomplete        To Be completed         Other (Specify)  ……………………………………………	
 
  Date:………………………………   Approved           Rejected             Other (Specify)………………………………………………………………..