IQRA Application Form - Special Needs - English
North America ONLY. Ages 6+. Please fill out a separate form for each student.
Child's Gender
*
Female
Male
Child's Name
*
First Name
Last Name
Child's Age
*
Parent's Name
*
Parent's Email
*
example@example.com
Parent's Email
*
Parent's Mobile Phone Number
*
For applicants outside North America, please select which calling service you have
Whatsapp
Telegram
None of the above
Country of Residence
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Country of Residence
*
United States
Canada
North American Time Zone
*
Pacific Time
Mountain Time
Central Time
Eastern Time
Atlantic Time
New Foundland Time
Alaska Time
Hawaii Time
Other
Student's Level of Quran Reading (select all that apply)
*
My child is completely new to Arabic
My child can identify Arabic letters
My child can imitate the sound of Arabic letters
My child can label Arabic letters
My child can read Arabic letters with vowel signs
My child can read basic Arabic words
My child can connect Arabic words together
My child understands some Tajweed rules
My child can read the Quran but makes frequent mistakes
My child can read the Quran and makes a few mistakes
My child can read the Quran fluently with little to no mistakes
Please certify the following (please read & select ALL seven)
*
My child can answer yes/no questions
My child can answer who/what/where etc. questions
My child can follow simple one-step directions
My child can communicate in English
I will be available during my child's class if the teacher requests my assistance
I will help my child to do their homework if needed
I understand that this application is not a guarantee of admission
Please state briefly what you hope for your child to achieve by taking this class
*
My child has been diagnosed with the following:
*
Autism
Down Syndrome
Dsylexia
Language Disorder (Receptive)
Language Disorder (Expressive)
Language Disorder (Pragmatic, i.e. social learning)
Specific Learning Impairment (please specify):
Other
My child's typical attention span (in minutes):
Please list your child's communications strengths & weeknesses
*
Does your child have any sensory sensitivities? If so, please explain:
E.g. hyper/hyposensitivity to auditory, tactile or visual stimuli
Does your child have any special interests?
*
This will help the teacher understand your child to better meet their needs.
Please explain anything else you feel we should know about your child's needs:
If you would like to include any professional evaluations pertaining to your child's diagnosis, please upload the file:
Browse Files
E.g. School-based multidisciplinary evalution, private clinic or medical evaluations etc.
Cancel
of
I am aware that... (please read & select all)
*
There will be an interview before admission & the Teacher will contact me when there is availability (please make sure both child and parent are present for the interview)
This class will focus SOLELY on proper pronunciation of Quran and Tajweed rules
This class will be conducted in ENGLISH
Preferred Class Duration (subject to availability)
*
20 minutes per session, 2x a week ($119 USD/month)
30 minutes per session, 2x a week ($178.50 USD/month)
20 minutes per session, 4x a week ($238 USD/month)
Available Class Timings (In New York time. Select ONE. Select two timings IF you chose 4x week)
I agree to the following policies (please read & select all)
*
Students are required to attend class regularly
Students must be punctual
Students arriving late will not be given extra time
Students should give a notice to the teacher as soon as they are unable to attend
Missing 4 classes in a row w/o notifying the teacher will cause a student to be dropped.
No make-up classes will be scheduled when a STUDENT cancels or misses a class.
The class will be made-up if the TEACHER cancels or misses a class because of an emergency.
Teachers will wait in the Zoom room for up to 10 minutes. If a student either does not inform they will be late or does not show, the time is forfeited for that day.
Parents are expected to show respect and cooperate with the teacher in supporting their child's needs.
Parent's are required to support their child as needed in completing the assigned homework.
There will be no sessions on set marked holidays.
Misbehavior or failure to adhere to the policies will cause a student to be dropped
Students canceling payments for ANY reason during enrollment (including holidays) forfeits their spot and will not be held for them for any reason.
Students are required to pass an oral assessment before moving on to the Mushaf regardless of prior experience.
Schedule your Interview Call
Select a time below to schedule a quick 10-15 min interview call where we will ask a few questions, explain more about the class and understand where you are in your Quran reading journey. Please have a copy of the Arabic Alphabet and a Quran Mushaf on hand. Please have your child present as well.
Interview Call Time slot
*
Please certify the following
*
The student will be on time for the Application Interview or else the student forfeits their spot.
If the student cannot show up on the time they have selected, the student will give a 2 hour minimum notice by emailing alhudaiqrao@gmail.com.
The student must be present/available during the call to speak to the interviewer.
The student understands the intention of this interview is for the teacher and student to decide if this class, IQRA, is a good fit.
The student understands if they are accepted into IQRA, they will have 48 hours to register and complete the payment or else the student forfeits their spot.
The student will set an alarm/reminder for the selected Interview time so they do not forget.
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