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Basic Contact Information
First Name
Last Name
Email
Phone/Mobile
City / Area you live in
Address
City
State
Zip Code
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Connection to IMCA & Community
Primary Connection to IMCA (Select One)
Masjid Al-Fajr Patron
MTI Parent
MTI Alumni
Weekend Academy Parent
Youth Program Alum
Food Pantry
Janazah Services
Crescent Clinic
General Community Member
How long have you been connected to IMCA?
Less than 1 year
1–3 years
3–7 years
7+ years
Other
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Education Background
Highest Level of Education Completed
Associate Degree
Bachelor’s Degree
Master’s Degree
Professional Degree (MD, JD, etc.)
Doctorate (PhD, EdD, etc.)
Other
Major / Field of Study
Accounting
Anthropology
Architecture
Art
Biology
Business Administration
Chemistry
Communication
Computer Science
Criminal Justice
Data Science
Economics
Education
Engineering
English
Environmental Science
Finance
Health Sciences
History
Information Technology
International Relations
Islamic Studies
Journalism
Law
Management
Marketing
Mathematics
Medicine
Nursing
Philosophy
Physics
Political Science
Psychology
Public Administration
Public Health
Religious Studies
Social Work
Sociology
Theology
Other
Institution(s) Attended (Optional)
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Professional Background
Current Title / Position
Organization / Company Name
Industry / Sector
Years of Professional Experience
0–5
5–10
10–20
20+
Professional Licenses / Certifications (if applicable)
Do you have board or nonprofit governance experience?
Yes
No
Are you a business owner?
Yes
No
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Skills & Institutional Contribution
Areas Where You Can Support IMCA (Select all that apply)
Board Governance
Finance & Budgeting
Legal
Fundraising
Education
Strategic Planning
Marketing & Communications
IT / Data Systems
Facilities / Construction
Youth Mentorship
Operations
Marketing
Education
Social Services
Janazah Services
Human Resources
SOPs & Procedures
Public Policy / Civic Engagement
Other
Level of Involvement You Are Open To
Advisory role only
Short-term projects
Committee service
Mentorship
Financial sponsorship
As needed
Estimated Availability Per Month
Less than 5 hours
5–10 hours
10+ hours
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Civic & Community Influence
Do you have professional or civic connections in any of the following?
Local Government
School Systems
Healthcare Systems
Corporate Leadership
Law Enforcement
Media
Interfaith Networks
Other (Specify)
None
Public speaking experience?
Yes
No
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Philanthropic Alignment
Areas of Giving Interest (Select all that apply)
Islamic Education
Youth Development
Masjid Operations
Civic Engagement
Social Services
Capital Projects
Endowment
Financial Sponsorship
Other
Does your employer offer corporate matching?
Yes
No
Unsure
Recommendation to IMCA and MPC
General notes
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