AL-AQSA COMMUNITY CLINIC - A clinic founded by Muslims, providing services for All.
                                                                 + 
 Assuring Access to Healthcare for ALL
 
Al-aqsa clinic  is now a member of Guilford Community Care Network (GCCN). Patients who  qualify will receive the orange card from Eligiblity & Enrollment and are required to present this card at each visit.
 
 Eligibility Requirements for GCCN
  • You must be a resident of Guilford County. 
  • You cannot be eligible for state or federal sponsored healthcare insurance, including Veterans Administration, Medicaid, or Medicare.   
  • 0-200% FPL
 
 Picture ID
  • Photo ID such as driver’s license, state identification card, passport, or identification from home country.
 
  •  Proof of Guilford County Residency
  
Proof of Income (All that apply)        
  • 1040/Last year’s tax return ·      
  •  W2 ·      
  •   Notarized Schedule C for self-employment verification ·       
  •  1099 ·      
  •  At least (4) current pay stubs ·      
  •   (Form 4506-T)- If taxes were not filled the previous year.  
  • Other income: social security, unemployment, child support, workmen’s compensation
  • Food Stamp Award Letter (if receiving assistance)-Informational Purposes ONLY
  • Notarized Letter of Support (If you have no income and receive shelter from an individual/organization)
 Proof of Assets (All that apply)
  • Current Bank Statement (checking, savings, CD’s, etc…)
  • If you are living on savings, you must provide three of your most recent bank statements.
  • Life Insurance Info (Case Value/Company Name)
  • Pension, 401-K, IRA, Gross Amount, etc…
  • Tax Value on autos, property, houses, mobile homes, etc…(Informational Purposes ONLY)
  • Disability Paper Work (if you have applied) Showing Status (Copy of Award Letter)
 
For College Students
  •   Documentation of how college is paid for (on school paper with logo) (print-out)  
  •  Copy (print-out) of any award letters 
  •  Copy of parental tax return
 
 
                                           1908 S Mebane St  Burlington, NC 27215
 336-350-1642
Fax: (336)395-8370