Federal EIN 20 4445779

AL KAUSER
P O Box 1032 East Windsor, NJ 08520
Phone 609 371 0982, 609 598 0942 Fax 609 371 0179 alkauser@comcast.net
Request for Educational Help (non US based Students)
Form AK 0003
Request for Scholarship: ___________Request for Loan Qarz e Hasna (QH): ______Date: ___________
Name: _______________________________________________Gender:_________________________
Father/Mother’s Name: _________________________________________________________________
Address: ______________________________________________________ Town__________________
Contact: Home#:___________________________ Mobile/Cell: _________________________________
Email: _______________________________________________________________________________
Passport/Government issued CNIC #: _______________________________ Type: _________________
Date of Issue: ____________________________ Place of Issue: ________________________________
Present Household Income: _________________ Total Family Member: _________________________
Signature: _________________________________ Date: _____________________________________
Education
Course Title: __________________________________________ Grade/Class: ____________________
Name & Address of Institution: __________________________________________________________
Tuition Fee: _______________ Other Expenditure Requested: _____________ Amount: ___________
Description: __________________________________________________________________________
Total Amount Requested: _______________________________________________________________
Last Institution attended: __________________________________ Grade/Class: _________________
Reference:
1. Name:__________________________________ Contact #/Email: _______________________
2. Name: __________________________________ Contact #/Email: _______________________
For Office use only
Approved: Yes/No: ____________________ Date: __________________________________________
Approved By: _____________________________________________ Date: ______________________
Note: Please attached transcripts of last school attended or other evidence of marks/results obtain.
Prove of household income. Description needs help for clothing/books or other expenses.

Al Kauser will help as scholarship but sister organization may grant as loan Qarza e Hasna (HS). I agreed to help the
community fellows as I get helped from the community members such as volunteer and/or pay back loan amount.