Spring/2023 Dual Credit Registration Form

Personal Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Student ID :
Address*

Street Address

Street Address Line 2

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Postal / Zip Code
Phone Number*
Email*
example@example.com
Name of high school
Please select the course you choose to take (Only 1 can be selected)*

QUR111 Quran Recitation & Memorization IHAD111 Analytical Interpretation of HadeethFIQ111 Fiqh of Worship IHIS213 The Biography of the Prophet

Admission fee*

Technology Fee

$15.00

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Total

$0.00

Summer 2023 Dual Credit Registration Form