Elfarouq Foundation
Suite 201, Stanmore Business & Innovation Centre, Howard Road HA7 1BT, 020 8459 3244, admin@elfarouq.org.uk
Application for Financial Assistance
Please read the “importance notes” section at the back of the form and the enclosed copy of “Elfarouq Foundation Policy” before filling the form

Forename	…………………………………………………..	Surname	…………………………………………………..	

Date of Birth: ………………	Country of Birth: ………………	Nationality ………………	Country of Residency ………………	

Sex:      Male     Female	Marital Status:     Single    Married	 Number of  Children 	 	
				
If married Full Name of Spouse: 			

 Permanent Address		 Temporary Address	

Address: ……………………………………………….……...…………..		
Address: ………………………..………………………….………………..	
………………………………………………………………..……….…..		………………………………………………………………..……….……..	
City: 	………………………….….   Post Code: ……….…………		City:	………………………….….   Post Code: ……………………	
Country:	……………………………………………………………….		Country:	……………………………………………………………..….	
Tel: 	……………………………..…  E-mail: …………………….		Tel:	………………………….…… Fax: …………………….…….	

Employment Status		Source of Income	

 Employed	
 Self Employed	
  Other (specify)		
 Employment	
 Savings	
 Other (specify)	
  Unemployed	  Student	…………………		 Family	 Loan	…………………	

Required Course Title	Course Certificate	Institution	Period 	Country	Starting Date	Finishing Date	
…………………………	……………	…………………………	………	…………		……	
Why have you chosen this subject and what are your future plans once you have completed this course? (Give your answer in separate sheet)
If the Board of Trustees request that you change your subject, are you willing to do so? 	                                                             Yes      No
(Give your answer in separate sheet detailing the other subjects that you would consider)

Education Back Ground for Secondary Certificate , Undergraduate and Graduate
	
Institution	Certificate	Subject/s	Grade/s	Country	Date  Awarded 	

						

Financial  Support Required	Currency:             Local             U$ Dollars         UK Sterling		
Financial Support	Amount	Period of Support	Installment	Note	
					
  Course Fees	…………	…………	 Monthly      Yearly      	……………………………………………………	
  Living Expenses	…………	…………	 Monthly      Yearly      	……………………………………………………	
  Medical Insurance	…………	…………	 Monthly      Yearly      	……………………………………………………	
  Other Expenses	…………	…………	 Monthly      Yearly  	……………………………………………………	
Please Specify and Explain: ………………………………………………………………………………………………………………………………………	
Do you intend to REPAY any funds you might receive from the Foundation:    Yes      No          If ( Yes ) , How

Are you eligible to receive grant/scholarship from your country or the university you are studying at or any other source?
  Yes      No 
If yes, please give details:
Have you received any financial assistance in the last five years from any source?                                                                  Yes    No
If your answer is yes please fill below:	
Type of Support:	 Fees    Living Expenses    Medical Insurance     Other Expenses	
Organisation	Country	Date	Amount	Type of Support	Others, describe 	
				1    2    3    4		
				1    2    3    4		
				1    2    3    4		
				1    2    3    4		

Are you seeking financial assistance from another source for the same purpose?                                                                   Yes        No	
Type of Support:	 Fees    Living Expenses    Medical Insurance    Other Expenses	
Organisation	Country	Applying Date	Type of Support	Decision	
			1    2    3    4	  Accepted     Refused     Pending	
			1    2    3    4	  Accepted     Refused     Pending	
			1    2    3    4	  Accepted     Refused     Pending	
			1    2    3    4	  Accepted     Refused     Pending	
Have you or one of your immediate members of the family applied to Elfarouq for financial support in the past?         Yes    No
If yes, when and what Type of Support was provided? (fore example: fees, living expenses or any other expenses)	
Name of the Applicant	Date of application	Amount Received	Type of support	Period of support	Rejected	

Language Proficiency	 Very Good                        Good                            Fair        	
……………………………………	Speaking:                    	Writing:                    	
……………………………………	Speaking:                    	Writing:                    	
……………………………………	Speaking:                    	Writing:                    	
……………………………………	Speaking:                    	Writing:                    	

Personal Referee (1)		Personal Referee (2)	

Name: ……………………………………………….……………..…..		
Name: ……………………………………………….…………………..	
Address: ………………………………………………...……….……..		Address: ………………………………………………...……………….	
………………………………………………………………..….……..		………………………………………………………………..…………..	
………………………………………………………………..….……..		………………………………………………………………..…………..	
City: 	……………………………  Post Code: ………………		City:	………………………….….   Post Code: …………………	
Country:	……………………….……………….……………….		Country:	……………………….……………….…………………….	
E-mail:	……………………….……………….……………….		e-mail: 	……………………….……………….…………………….	
Tel:	……………………….……………….……………….		Tel:	……………………….……………….…………………….	
Fax:	……………………….……………….……………….		Fax:	……………………….……………….…………………….	

Academic Referee 		Institution 	

Name: ……………………………………………….……………..…..		
Name: ……………………………………………….…………………..	
Address: ………………………………………………...……….……..		Address: ………………………………………………...……………….	
………………………………………………………………..…………..		………………………………………………………………..…………..	
………………………………………………………………..….……..		………………………………………………………………..…………..	
City: 	……………………………  Post Code: ………………		City:	………………………….….   Post Code: …………………	
Country:	…………………………… e-mail:  .……………..….		Country:	……………………….……… e-mail:  .………….……..….	
Tel: 	…………………………… Fax:….………………….		Tel:	……………………….……… Fax: ……….……………….	

Supervisor 	

Name: ……………………………………………….……………..…..		
Faculty: ……………………………………………….…………………..	
Address: ………………………………………………...……….……..		Department: …………….……………………………...……………….	
………………………………………………………………..….……..		E-mail:  ………………………………………………………..…………..	
City: 	……………………………  Post Code: ………………		Tel:	………………………..…….…. Extension: …….…………	
Country: 	……………………………………..………………….		Fax:	……………………….…………….…………………..…….	

Personal Bank Details		Institution Bank Details	

Bank Address:  …………………………………………..………..…		
Bank Address:  …………………………………………..……………...	
………………………………………………………………..…….…...		………………………………………………………………..…….…..…	
City: 	…………………….….   Post Code: ………………		City:	…………………….….   Post Code: …………...…	
Country:	……….………………………………………….….		Country:	………………………………………………….….	
Tel: 	………………………………………………….….		Tel:	………………………………………………….….	
Account Name:	………………………………………………….….		Account Name:	………………………………………………….….	
Account No:	……………………………………………………..		Account No:	………………………………………………….….	
Sorting Code:	…………… Branch:  …………..…………………		Sorting Code:	…………… Branch:  …………..…………………	

Are you an active member of the Muslim Community? ( describe the nature of your accomplishment and activities below if the space is not enough you may use separate sheet)	
…………………………………………………………………………………………………………………………………………………………………………...	
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Declaration 	

I have read and understood the policy of Elfarouq Foundation.  I declare that, I have not received any funds, loan, grant or scholarship for the same purpose for which I have applied to Elfarouq Foundation. The information I provided herein are true and accurate to the best of my knowledge.	

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

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

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

IMPORTANT NOTES
Complete all sections of this form in BLOCK CAPITAL letters.
PROVIDE all required documents.
Failure to do so will delay the processing of your application and may result in refusal.
You may use additional sheet/s if the provided space is not enough.
Keep a copy of this application for personal reference.
Acknowledging receipt of an application does not mean a commitment or an undertaking by the Foundation to provide assistance.	

References And Supporting Documents
Please provide the following documents: (failure to do so will result in refusal of your application)
1.	Two letters of recommendations form two references who know you personally. Include their current mailing addresses, email address, telephone and fax numbers.
2.	A letter from reputable active Muslim Organisation in your country and/or from the country of residence if you have been living for more than two years in.
3.	A letter of recommendation from a person who is well acquainted with your academic work (supervisor, teacher, tutor, etc.)
4.	Authenticated copies of your certificates (from Secondary School and higher).
5.	A letter/s from the institution confirming:
date of enrolment, expected date of completion, amount of fees, tuition, living expenses and institution’s bank details   (fees and tuition are paid to the institution directly)
6.	Copies of your bank statements for the last six month and details of your own bank account.
7.	A copy of passport and/or ID card and one recently taken photograph.