HIKMAH ACADEMY (BURNSVILLE CAMPUS) ADMISSION FORM

HIKMAH ACADEMY
Admission Form
Section 1: Student Details
First Name*
Middle Name
Last Name*
Date of Birth*

MonthDayYear
Date
Place of Birth*
Nationality*
Grade Completed*
MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mian Contact's Full Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship*
Emergency Contact Name (non-parent)*
Emergency Contact Phone Number*
Please enter a valid phone number.
Section 2: Academic Details
Grade in which admission is sought*
Name(s) of school(s) attended in the past and dates of attendance:
Name of School (Include City/State/Country)
Example: Abcd Academy, Prior Lake, MN, USA
Grade(s)
From (Date)
MM/YYYY
To (Date)
MM/YYYY
Name of School (Include City/State/Country)
Example: Abcd Academy, Prior Lake, MN, USA
Grade(s)
From (Date)
MM/YYYY
To (Date)
MM/YYYY
Name of School (Include City/State/Country)
Example: Abcd Academy, Prior Lake, MN, USA
Grade(s)
From (Date)
MM/YYYY
To (Date)
MM/YYYY
Name of School (Include City/State/Country)
Example: Abcd Academy, Prior Lake, MN, USA
Grade(s)
From (Date)
MM/YYYY
To (Date)
MM/YYYY
Section 3: Parent/Guardian Information
Father's Full Name*
Profession*
Employer*
Cell Phone Number*
Email
example@example.com
Office Phone Number
Office Address
Mother's Full Name*
Profession*
Employer*
Cell Phone Number*
Office Phone Number
Email
example@example.com
Office Address
Section 4: Rules & Regulations
Hikmah Academy provides a protective. caring and Islamic environment for our children. Some of the rules and regulations are described below. Girls and boys will have separate classes from Grade 4 or 5, depending on logistics. All students are required to attend school in uniform. The Academy is not equipped to teach students with special needs or manage behavior disorders at this time. Any student experiencing a communicable illness must not attend school until he/she fully recovers. For the safety of all students, anyone suspected of carrying one will be sent home. All students are expected to follow the school regulations and demonstrate a high standard of Islamic conduct at all times. Any behavior that violates the Academy's code of conduct will be reprimanded and may result in suspension. This Academy is established to enhance and strengthen the highest Muslim academic and ethical standards in the students and will use all acceptable means to achieve that objective. Total annual tuition will be divided into a maximum of 10 months. Parents are responsible to pay the required tuition during the 3rd week of the previous month.

confirm that, to the best of my knowledge, the information provided in this form is correct. / understand and agree to abide by all Hikmah Academy rules including discipline, tuition fee payment and refunds / also acknowledge that while the academy does its best to ensure the safety of each child's life, health and property, the academy cannot be held responsible for any damage to these.
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
Date
Signatory's full name*
Signatory's relationship with the student*
Section 6: Admission Procedure
1. Complete Hikmah Academy admission form.
2. Pay non-refundable admission fee to Hikmah Academy.
3. Copy of birth certificate or passport.
4. Gas, electric or water bill from the past 60 days which includes your name and residential address.
5. Immunization record from pediatrician or notarized waiver.
6. Academic records from the previous school [if applicable].
Should be Empty:

HIKMAH ACADEMY

Admission Form

Section 1: Student Details

Section 2: Academic Details

Section 3: Parent/Guardian Information

Section 4: Rules & Regulations

Section 6: Admission Procedure