Documents:  Application checklist   |    Promissory Note

Important Instructions:

  • Complete Borrower Application below.
  • Review Application Checklist and all Terms & Conditions. This document must be signed by applicant and both parents and submitted with all supporting materials outlined.
  • Review and complete Promissory Note. This document must be signed and notarized in 2 places -once by the applicant and once by the Guarantor.
  • Mail signed Application Checklist Terms & Conditions, all supporting documents, and signed and notarized Promissory Note to:
             Anjuman Wazifa Sadat O Momineen | P.O. Box 844 | Hicksville, NY 11801

Please note Last date for receiving completed applications by mail is June 30 for the fall semester and November 30 for the spring semester. An application which is late, hand delivered, or incomplete in any way will not be considered.


Borrower Application

Personal Information

New or Continuity?
First Name Middle Initial Last Name Date of Birth (mmddyyyy)
Phone Fax Email
Legal Status
(check one)
 US Citizen Permanent Resident Student Visa (F1 or J1) Other If not US Citizen, Country:
Street Address City State Zip Code
Income earned by student Other Taxable Income Non-Taxable Income & Benefits Other Educational Aid Expected Loan needed for Semester/Term
$ $ $ $ $

Academic Information

Name of Educational Institution
Street Address City State Zip Code
Degree Expected Program of Study
Expected Graduation Date Cumulative GPA
Tuition Room & Board Books Other
$ $ $ $

Family Information

First Name Last Name Relationship DOB (mmddyyyy Student?