Application for Vehicle Waiting List

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The MCC Vehicle Donation Program is exclusively for San Francisco Bay Area Muslim residents. MCC facilitates donated vehicles on a need-basis and vehicle donors in the community offer vehicles for donation through MCC.

MCC only facilitates this donation to your family. We do not control the duration of a person’s wait time on the waiting list.

The car waiting list for eligible applicants is six months to one year.

If you have questions, don’t hesitate to contact MCC’s Zakat Administrator, Sister Aminah Abdullah, at aminah@mcceastbay.org or (925) 264-9297.

Vehicle Waiting Application – MCC East Bay

1. ABOUT THE APPLICANT

Name

First Last

Today's Date(Required)

MM slash DD slash YYYY

CA Driver's License Number(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please write “homeless” if the deceased did not have a permanent address.

Your Email Address(Required)

Enter Email Confirm Email

Cell Phone Number(Required)

Secondary Cell or Home Phone Number

Are you working now?(Required)

Full-Time

Part-Time

Unemployed

Self-Employed

Other

Have you applied for any assistance from MCC before?(Required)

Yes

What field of work are you working in now or were most recently employed in?(Required)

If working, company name?(Required)

Salary:(Required)

Job Position:(Required)

If working, how far is your commute and how do you currently get to work?(Required)

Did you arrive to the U.S. under a federal refugee resettlement program in the past two years?(Required)

Yes

If yes, when did you arrive in the U.S., via which agency, and what is your country of origin:

2. ABOUT YOUR HOUSEHOLD

Your marital status:(Required)

Married

Separated

Divorced

Widowed

Single

If married, is your spouse currently employed?(Required)

Yes

If yes, where does your spouse work (company name & address):

Does your spouse have a vehicle?

Yes

Enter the name, date of birth, and relationship of each person living in your household:(Required)

3. ABOUT YOUR HOUSEHOLD INCOME AND EXPENSES

Monthly Gross Income:

Income From Work (you and your spouse)(Required)

Social Security Income(Required)

Child Support(Required)

Aid/Welfare, Food stamp(Required)

Family Assistance(Required)

Other Sources:(Required)

Specify other:

Total:(Required)

Monthly Expenses:

Rent/mortgage(Required)

Utilities/Phone(Required)

Food(Required)

Car payment, Insurance(Required)

Medical expenses(Required)

Other (i.e. debt and loan payments)(Required)

Specify other:

Total:(Required)

Current Household Assets:

Checking(Required)

Savings(Required)

Gold or Silver (cash value)(Required)

Vehicle(s) (fair market value)(Required)

IRA, Pension, Stock, mutual funds(Required)

Other (cash value)(Required)

Total:(Required)

4. VEHICLE IMPACT STATEMENT

What were the circumstances around becoming car-less?(Required)

Is your intent in asking for a vehicle so that you may use this vehicle for ride-sharing (Uber/Lyft)?(Required)

Yes

How would receiving a vehicle donation positively impact your household? (BE DETAILED; do not just state a vehicle would help your household.)(Required)

Have you ever received a car via any other donation program?(Required)

Yes

Are there currently any other vehicle(s) in your household?(Required)

Yes

If yes, what is/are the year, make, and model and who owns each?(Required)

Which type of vehicle would have the most impact on your household?(Required)

Coupe (two-door vehicle)

Sedan (four-door vehicle)

Full-Size Vehicle

Minivan

Pickup truck

Before you may pick up a vehicle from MCC, obtaining and showing proof of insurance is mandatory. How will you do so?(Required)

5. REFERENCES

Please list at least two names of references whom you are familiar with and who can confirm or verify the information you provided in this application. References cannot be immediate relatives or people you live with.

Name, phone, relationship to you:(Required)

Please check each box on this checklist to confirm your understanding and that you are submitting a true and complete application to the MCC:(Required)

Yes, I have included a CLEAR COPY of my California Driver’s License in the Document Upload section below. Please do not complete form if you are not a licensed California driver.

Yes, I understand that simply completing this form does not mean automatic approval of the application. I maybe asked to provide supporting documents to substantiate the validity of information I have provided.

Yes, I understand that MCC’s Vehicle Donation Program is exclusively for residents living with a valid address in the San Francisco Bay Area. MCC facilitates donated vehicles on a need-basis and as vehicle donors in the community offer vehicles for donation through MCC. MCC facilitates the donation and it does not control the duration a person waits on the waiting list.

Yes, I understand that I will be responsible for insuring the vehicle before I may pick the vehicle up from MCC. If I cannot afford to insure the donated vehicle, once or if MCC contacts me with a waiting vehicle, I may complete a Zakat application (downloadable at mcceastbay.org/zakat for the MCC Zakat Committee to consider payment on a three-month policy or a six-month policy on a donated vehicle).

6. STATEMENT: Please read the following statement and sign below.

1. I testify in front of God that the information provided in this application is true and accurate to the best of my knowledge. I understand that if any information given turns out to be untrue, this application will automatically be denied and that MCC may permanently bar me and my spouse from applying for any future assistance as well as sharing my information with other Bay Area masjids that give out Zakat and Sadaqa assistance.

2. I understand that the MCC Car Program will automatically reject any application we receive that is incomplete. I will not hear back from the team and I will not be added to the waiting list, if I submit this form with missing information.

3. I understand that the MCC Car Program is a popular program and we currently have about 75 families on the waiting list. We cannot provide a date for when you may receive a vehicle. The current wait time is six months to one year.

To agree that you understand the above three statements, please enter your name below as a signature.(Required)

Today's Date:(Required)

MM slash DD slash YYYY

7. DOCUMENT UPLOAD

Copy of California Driver's License (required)(Required)

Max. file size: 512 MB.

Programs

MCC Sunday School

After-School Qur’an Classes

Children’s Arabic Program

Friday Night Girls Halaqa

Youth Programs

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Marhaba: Convert Care and Community

Cub Scouts

Women’s Halaqa with Dr. Rania

Services

Du’a Request

Mental Health

Ask an Imam

Immigration

Suggest a program or speaker

Islamic Divorce Services

Nikah Marriage Services

Quarterly Matrimonial Gatherings

Facility Rental Form

Assistance

Zakat & Sadaqa

Food Pantry

Refugee Support

Funeral & Burial

Bay Area Nonprofits

Clothing Donations

Bike Donation

Furniture Donation

Vehicle Donation