As-Siddiq Assistance Request

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As-Siddiq Assistance Request

This form is used to request assistance for those impacted by the COVID19 Coronavirus Pandemic. Requests are evaluated based on the information provided in this form and any follow-up information. Any assistance provided is needs-based and subject to funds available at the time of request. May Allah Subhaanahu Wa Ta’ala protect and help us all.

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* Indicates required question

Email *

Your email

First Name *

Your answer

Middle Name

Your answer

Last Name *

Your answer

Street Address *

Your answer

City *

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State *

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NY

Zip Code *

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Phone *

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