Masjid Family Survey Form

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Basic Information:

Head of the Family Name *

Masjid *

Phone *

Address *

Duration of Stay *

Ownership of House *

Gender *

Birth Date *

Occupation *

Family Members:

Family Member #1

Name *

Birth Date *

Gender *

Relation to Head *

Educational Qualification *

Studying

School / College Name

Occupation

Islamic Education Level

Financial Status:

Total Monthly Family Income (₹)

Main Source(s) of Income *

	Yes	No
Any Unemployed Members Seeking Job?
Any Widow / Orphan in Family?
Any Debts or Loans?
Receiving Financial Aid (Zakat / NGO / Govt)?

Comments

Religious & Social Engagement

	Yes	No
Do all members perform daily Salah?
Do male members attend Masjid for Salah?
Do women attend Islamic classes?
Children attending Islamic weekend classes?
Any non-practicing Muslims needing guidance?
Family participation in Masjid programs

Comments

Health & Welfare

	Yes	No
Any member suffering from illness/disability?
Access to Govt Healthcare/Insurance?
Any family member needs medical help?
Need monthly ration support?

Comments

Community Support & Suggestions

	Disagree	Neutral	Agree
Would you like to join any Masjid initiatives?
Suggestions to improve Masjid / community activities
Permission to contact for welfare programs

Comments

Surveyor Details:

Surveyor Name *

Phone *

Date of Survey *

Auth Code / Verification *

Please enter the verification code shown in the image above

✓

Thank You!

Your survey has been submitted successfully.

Upcoming Event:

4TH TAAQRAAT -16 MARCH 2026

Basic Information:

Family Members:

Family Member #1

Financial Status:

Religious & Social Engagement

Health & Welfare

Community Support & Suggestions

Surveyor Details:

Thank You!

Zakat Collections

Quran Stories Day 1