Student Application Form Falah Seminary

Student Application Form

Fill out the form carefully for registration to Falah Seminary (Aalim and Hifz program).
Section 1: Student Information
Student Name

First Name Middle Name Last Name
Father/Guardian Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Address

Street Address

Street Address Line 2

City State / Province

Zip Code Country
Student E-mail
example@example.com
Mobile Number

Area Code Phone Number
Phone Number

Area Code Phone Number
Upload Photo of ID

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Valid ID copy Cancel of
Section 2: Parents/ Guardian Information
Father/ Guardian Name

First Name Last Name
Relationship to Applicant
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Father/ Guardian Phone Number

Area Code Phone Number
Father/Guardian Email
example@example.com
I attest that the applicant is applying under my care and support.

Yes No
Section 3: Secular Education
Latest School Attended
Grade
GPA
School Certificate/Diploma Received
Upload copy of certificate/ Diploma

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Cancel of
Section 4: Medical Information
Does the Applicant have any medical complications that need permanent medications?
Does the Applicant have Medical Insurance that works outside the State?
Upload Insurance Card

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Cancel of
Did the Applicant receive the Covid-19 Vaccination?

Yes No
Upload Vaccination Certificate

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Cancel of
Section 5: Jamaat Effort History
How long have you gone on Jamaat?
Did your father/guardian spend time in Jamaat?
Section 6: Financial Information
What is the most convenient way for you to pay the fee?
Section 7: References
Aalim 1 Name

First Name Last Name
Aalim 1 Phone Number

Area Code Phone Number
Aalim 1 Email
example@example.com
Upload Recommendation Letter from Aalim 1

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Cancel of
Aalim 2 Name

First Name Last Name
Aalim 2 Email
example@example.com
Aalim 2 Phone Number

Area Code Phone Number
Upload Recommendation Letter from Aalim 2

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Cancel of
Section 8: General Questions
1. Why are you applying for Madrassa?
2. Why are you choosing this institute?
3. How did you hear about us?
4. Have you spoken to one of our teachers? If so, what is their name?
Should be Empty:

Student Application Form

Section 1: Student Information

Section 2: Parents/ Guardian Information

Section 3: Secular Education

Section 4: Medical Information

Section 5: Jamaat Effort History

Section 6: Financial Information

Section 7: References

Section 8: General Questions