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Registration

U & I Tahfeez Application for Admission

Section 1 — Student Information

Anticipated Start Date

First Name

Middle Name

Last Name

Date of Birth

Gender

Male

Female

Passport Photograph

Choose File

Birth Certificate/Age Declaration

Choose File

Current Level of Education (if any)

Home Address

LGA of Origin

State of Origin

LGA of Residence

State of Residence

Home Address

LGA of Origin

State of Origin

LGA of Residence

State of Residence

Section 2 — Health

Please specify any health challenges that the school should be aware of, such as asthma, epilepsy, sickle cell anemia, allergies, etc.

Medical Allergies

Section 3 — Guardian / Parent Information

Gender

Male

Female

Passport Photograph

Choose File

Address

Home Address

Office / Business Address

City

State

Relationship to Student

Parent/Guardian Phone Number

Parent/Guardian Email

Occupation

Alternate / Emergency Contact

First Name

Middle Name

Last Name

Contact Phone Number

Section 4 — Quran / Memorization Background

Can the applicant read the Qur'an in Arabic?

Yes

No

Current Memorization Level

Number of Juz Memorized (approx.)

Recitation Style / Riwayah

Previous Quran Teacher or School (if any)

Section 5 — Program & Fee Tier

Program Type

Full-time Hifz (Boarding)

Full-time Hifz (Day)

Sibling Already Enrolled?

Yes

No

Signature

Sign Here

Date / Time