EIC Help Line Form: COVID-19
This is an application to receive financial assistance from the Evergreen Islamic Center (EIC). EIC is not obligated to assist but aims to offer aid to those in need from its Sadaqah funds. Our goal is to attempt to help everyone regardless of race, gender, or religion.

Note: YOU MUST LIVE IN THE SANTA CLARA COUNTY to be eligible.

EIC reserves the right to accept or deny this application based on the verification of the information provided. Please complete all fields. An incomplete application will not be processed.

A sample application form - https://drive.google.com/open?id=1dlYq9LwgHtjyMJqJBMVs-otESidUPisM
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Full address (where checks should be mailed - NO PO BOX): *
Phone number *
Email address *
Do you live in the Santa Clara County? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy