Taleem al Qur'an 2012 On Site Registration Form
Please fill out the form below to register for the Taleem al Qur'an 2012 course. This registration form is the first portion of a multi-step admissions process. Please ensure you enter a valid email address that you check often. All future correspondence will be through email.
 

Personal Information

First Name:

Last Name:

Date of Birth:

   
Address:

City:

Province:

Country:

Postal Code:

   
Home Phone:

Cell Phone:

Email:

 

Background Information

Name of Parent/Guardian:

Relation with Guardian:

First (Native Language):

Country of Origin:

 

Educational/Work History
Highest Level of Education:

 
Current School: (if applicable)

 
Current Grade: (if applicable)

 
Main Subject of Study:

 
   
Employment Status:

 
Current/Most Recent Employer:

 

 

Supplementary Services Request
Do you require Childcare?

For how many Children? Ages:

 

 

Medical Details
Do you have any medical conditions that may impact your study at Al Huda Institute or that may require attention while you are on campus? If so, what are they?

 

 

Emergency Contact Information
Name:

 
Relationship:

 
Phone Number:

 

 

 

Disclaimer:  Please note that students are not accepted or rejected on the basis of ethnicity, age, marital or work status.  This information is collected solely to help the Institute better understand it's future student body.  Also note, this information is completely confidential and will not be shared with any third party.  If you have any questions in regards to the information collected in this form, or about the admission process in general, please do not hesitate to contact someone in the administration at Al Huda Institute.