Sadaqa / Zakat and Assistance

Madina Masjid offers assistance for those in need. Your information will be kept strictly confidential. Please complets this form and someone will reach out to within 24 hours.

Who receives Zakat:

  • The Poor (al-Fuqara’)
  • The Needy (al-Masakin)
  • Zakat Administrators (al-A’mileen’)
  • Those whose hearts may be reconciled (al-Muallafti Qulubihum)
  • Those in debt (al-Gharimeen)
  • Those struggling in the way of Allah (fi sabil lillah)
  • Wayfarers (ibn as-Sabil)

Zakat Form


Phone Number
Address House or Apt Number

Address Street Name
Address City

Address Zip
Address State

Comments (State your need here)

Are You Working
How many members in your house

Do you rent or pay a mortgage?
Please explain why you are in need of Zakat. Include information about any special circumstances.

Current Income (Monthly)
Are you receiving any other Government Assistance:

If Yes then how much

References - Please list the names/numbers of 3 individuals who know of your situation