Yarrow Mamout Scholarship Application
Miraaj Academy Inc offers financial assistance for converts or descendants of converts to attend Yarrow Mamout Qur'an and Leadership Program. Scholarship funds are limited and will be awarded to students based on financial need. This scholarship is intended to assist families who demonstrate a financial need and we encourage those in need of assistance to apply. Scholarship decisions will be based primarily upon financial need and consideration will be given to students who make a commitment to complete the Yarrow Mamout program for two years. Please be assured that all information provided herein will be kept in the strictest confidence by the scholarship committee of Miraaj Academy.
Student Information
First Name
*
Enter one word without spaces
Middle Name
Enter one word without spaces
Last Name
*
Enter one word without spaces
Date of Birth
*
-
Day
-
Month
Year
Date
Total Cost of the Program
*
Please make sure this amount matches the fee invoice you will upload.
Is the student currently receiving any type of financial aid?
*
Yes
No
How much aid are your requesting?
*
Number of siblings under the age of 18
*
Please Select
0
1
2
3
4
5
more than 5
Family Information
Father's Name
*
First Name
Last Name
Mother's Name
*
First Name
Last Name
How much is your family able to contribute towards your child's program costs?
Enter the previous monthly income.
Financial Information
How many earning members are there in your household?
*
Please Select
1
2
If there are more than 4 earning members in your household, please enter information for the four highest earning members.
Primary Income Earner Information
Name
*
First Name
Last Name
Occupation
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Relationship to the student(s)
*
Parent
Guardian
Self
Type of employment
*
Salaried
Self-employed
Annual Income
*
Enter the previous monthly income.
Proof of income (please upload supporting documentation)
*
Browse Files
Eligible documents include: (a) Most recent copies of your IRS 1040 Form please black out your social security numbers. (b) Copies of your pay slips of last three months. (c) Business profit/loss statement for the last 12 months
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Secondary Income Earner Information
Name
First Name
Last Name
Email
example@example.com
Occupation
Phone Number
-
Area Code
Phone Number
Relationship to the student(s)
Parent
Guardian
Self
Type of employment
Salaried
Self-employed
Annual Income
Enter the previous monthly income.
Proof of income
Browse Files
Eligible documents include: (a) Most recent copies of your IRS 1040 Form please black out your social security numbers. (b) Copies of your pay slips of last three months. (c) Business profit/loss statement for the last 12 months
Cancel
of
Financial Impact - Additional financial factors the committee should take into consideration when reviewing the application
If a family member has lost his/her job in the past 12 months, please state here.
50 word limit
0/50
Please explain how any significant change in income has impacted you financially.
200 word limit
0/200
Household Expenses
Do you have monthly housing payments (rent or mortgage) on your home?
*
Yes
No
Total monthly housing expenses
*
Total debt related monthly expenses
*
Enter the total monthly amount paid on outstanding debt or loans (do not include housing)
Other household expenses (ex. utilities, food, sibling tuitions, childcare extracurricular activities)
*
Enter any other monthly household expenses .
Other expenses
Please specify type of expense and monthly amount.
0/50
Supporting documents for debt related expenses
Browse Files
Please include any supporting documentation for outstanding loans or other expenses. This will assist the committee in making award decisions.
Cancel
of
Contact Information
Primary Contact Person
The following contact information will be used by the scholarship committee to contact you regarding supporting documents and a final decision. Please double-check to make sure the data you enter is correct.
Primary Contact Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Primary Contact Phone
*
-
Area Code
Phone Number
Primary Contact Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DISCLOSURE, WAIVER, AND AFFIRMATION
By Submitting this form, I affirm to have read and understood the terms and conditions of the Yarrow Mamout Scholarship Program. I understand that the information disclosed in this application shall only be accessible to authorized persons who shall review this application. I affirm the information provided in this application is true and correct to the best of my knowledge. I affirm a commitment to send my child to the Yarrow Mamout Leadership program for at least two years Insha Allah. Any false representation to any of the information I have disclosed may cause my disqualification to the program.
Signature
*
*This application can only be signed by the parent/guardian registered at the school.
Please verify that you are human
*
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Submit
EmailGenerations
*
scholarships@miraajacademy.org
EmailLecole
*
example@example.com
Today's Date
*
-
Day
-
Month
Year
Date
Should be Empty: