Academy

All students' applications must be filled out entirely to complete the registration.

Parents should submit copies of the following records: Medical Assessment Birth Certificate Immunization Record
First
Last
Grade
Middle
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth Month/Day/Year
Place of birth
Other Citizenship
English is a second language at home

YesNo
1. Is a language other than English used in your home?

YesNo
If yes, please fill out the following ,2. Is that language spoken in the home

More often than EnglishLess often than English
3. What language is spoken by the adults in the home?
4. What is the first language your child learned to speak?
5. What was the date (month and year) your child first enrolled in any U.S. school (Private or Public, but not PreK) Indicate if the student left the U.S. for a school year(s)

MonthDayYear
Date
6. How many years has this child been in school in the US?

All parents are required to complete 10 hours of mandatory school service during the academic year. Please check the type of service you will provide.

Assisting with CI Academy Fundraising events. Being a Homeroom Parent Picture day Event (once a year for a day) Hajj Program Quran Competition Graduation (Preparation and the actual day) Science Fair Day (All Day) Assisting classroom teachers (i.e copying. collating papers) Teaching extra-curricular programs once a week (computer skills, sewing, arts & crafts, Quran, Arabic, sports, other) Cleanup - (re-arrange classrooms, dusting. cleaning. etc Painting various rooms in the building. Other:

Heading
Parents should submit copies of the following records:

Medical Assessment

Birth Certificate

Immunization Record
Medical Assessment

medical assessment
Cancelof
Birth Certificate

birth certificate
Cancelof
Immunization Record

immunization record
Cancelof
By signing this application, I agree to abide by the policies and regulations of Charlotte Islamic Academy. To the best of my knowledge. the information I have given is accurate. I understand that any misrepresentation of facts on this application may cause for the refusal of admission, financial aid, cancellation of admission, or suspension from the school.

Iunderstand that if my child withdraws or transfers to another school, transcripts from Charlotte Islamic Academy will be withheld until all past-due fees, fines, and tuition are settled.
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Registration Fees*

Registration FeeMake sure you choose the right Quantity where Quantity means how many students you are registering in our school to pay once

$50.00 Quantity
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