Student application form

Complete the form below to register a new student. Our school team will review it and contact you, in sha Allah.

ٱقْرَأْ بِٱسْمِ رَبِّكَ ٱلَّذِى خَلَقَ

“Read in the name of your Lord who created.” — Surah Al-'Alaq 96:1

Student information

Tell us about the student applying.

1.Student's full name *

2.Date of birth *

3.Gender *

4.Current grade in regular school *

Help us place the student in the right class.

5.Program applying for *

6.Preferred schedule *

7.Quran reading level *

8.Arabic language level *

9.Previous Islamic education (optional)

Who should we contact about this application?

10.Parent / guardian full name *

11.Relationship to student *

12.Email address *

13.Phone number *

14.Home address *

So we can keep every student safe.

15.Emergency contact name *

16.Emergency contact phone *

17.Allergies or medical conditions (optional)

18.Learning or special needs (optional)

Almost done!

19.May we include the student in event photos? *

20.Questions or comments (optional)