Miraaj Academy - Admission Application

Miraaj Academy - Admission Application

Application for the Sacred Seeds Elementary Program
Applicant Information
Student's Name

First NameMiddle NameLast Name
Address

Home Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry
Age
Date of Birth (Mo/Day/Year)

MonthDayYear
Date
Country of Birth
Country of Citizenship
Home Telephone (include country, city, and area codes)
Format: (000) 000-0000.
Cell Number (include country, city, and area codes)
Current Grade Level
GPA
HomeschoolPublic SchoolIslamic Private SchoolOther Private School
YesNo
Parents are marriedParents are divorced
If parents are divorced, who has legal custody of the applicant?

Father
Name
Address (if different from the potential student)

Home Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry
Primary Telephone (include area codes)
Format: (000) 000-0000.
Email Address
Mother
Name
Address (if different from the potential student)

Home Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry
Primary Telephone (include area codes)
Format: (000) 000-0000.
Email Address

Parent Communications

Rows	Father	Mother	Both Parents
Where should bills be sent?
Where should we send school materials?

YesNo

Name of Previous School
Dates of Attendance (Start date)

MonthDayYear
Date
Dates of Attendance (End Date)

MonthDayYear
Date
Address

Address

Street Address Line 2

CityState/Province

Postal / Zip Code
City
State/Province

YesNo
How much of the Quran is the student able to memorize in a day? (ex 2 ayats, 1 page ..)
1. Please list the surahs or the number of ajza the student has memorized
2. Describe the student's level of proficiency with reading and writing Arabic
3.What books has the student read in the past year?

Signature
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