Miraaj Admission Application

Yarrow Mamout Leadership Application
Applicant Information
Name

First NameMiddle NameLast Name
Address

Home Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry
Age
Date of Birth (Mo/Day/Year)

MonthDayYear
Date
Country of Birth
Country of Citizenship
Email Address
example@example.com
Home Telephone (include country, city, and area codes)
Cell Number (include country, city, and area codes)
Please select the Yarrow Mamout Program

BoardingDay
Current Grade Level
GPA

Parent Information
Father
Name
Address

Home Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry
Primmer Telephone (include country, city, and area codes)
Email Address
Mother
Name
Address

Home Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry
Primary Telephone (include country, city, and area codes)
Email Address

Parent Communications

	Father	Mother	Both Parents
Who does the applicant live with?
Where should bills be sent?
Where should we send school materials?

Check if appropriate

Parents are marriedParents are divorced
If parents are divorced, who has legal custody of the applicant?
Are you applying for financial aid?

YesNo

Previous School
Name of Previous School
Dates of Attendance (Start date)

MonthDayYear
Date
Dates of Attendance (End Date)

MonthDayYear
Date
Address

Address

Street Address Line 2

CityState/Province

Postal / Zip Code
City
State/Province

Admission Questionnaire (applicant should complete this section
1. List and describe your level of interest and participation in school activities school, volunteer groups, athletics, music, etc List any awards or honors you received in the past two years. Include an activities sheet if available.
2.List and describe your level of interest and participation in Islamic activities. I.e.classes, conferences, etc
3. List and describe your level of interest and participation in activities associated with community service
4. Why are you applying to Miraaj Academy and what do you hope to gain from attending this program?
4. Describe your level of proficiency with Arabic
5.What books have your read in the past year?
6.Explain the impact of an event or activity that has created a change in your life or in your way of thinking.

Sign and Submit
Signature

Clear
Should be Empty: