ICMC Community Help Request
Asalamu Alaikum wa rahmatullah,

Our community at ICMC would like to help those who are in need during this time (those who are elderly, special needs, lack of transportation, etc). The Muhsen committee has put together this request form for those who are in need of  help or support from a local volunteer. If you or a loved one are in need of support, please kindly fill out this form and we will be in touch with you shortly.

Services include but are not limited to: Grocery shopping, support via video call, buddy matching, tutoring, revert support, etc.
*Please note this form is not valid for financial assistance.

If you have any questions, please do not hesitate to reach out to us at icmcmuhsen@gmail.com 
*We will try our best to respond to all inquiries within 48 hours.

Jazak Allah Kheir.
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Full Name: *
Are you a brother or sister? *
Email: *
Cell Phone Number: *
How can we be of service to you? Please describe what type of help is needed. *
If you need help on a specific date, please list it below:
MM
/
DD
/
YYYY
If you need help which requires a volunteer to come to you (groceries, elderly help, etc.), please include your address or the area/ town in which you live:
If you are filling this out on behalf of someone who is not fluent in English, please indicate the preferred language below:
If you are filling this out on behalf of someone else, please leave your name and phone number below:
Comments/ Concerns:
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