Al-Fitrah Tarbiyah Foundation Youth Program
Student Application Form
📌 Please complete this form accurately. Yourresponses will help us understand how to best support your growth during theprogram.
SECTION A: Personal Information
Full Name (Student)
*
First Name
Last Name
Gender
*
Please Select
Female
Male
Date of Birth
*
 -
Month
 -
Day
Year
Date Picker Icon
Phone Number (Student)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email - Student (If Available)
example@example.com
SECTION B: Parent/Guardian Information
Parent/Guardians Name
*
First Name
Last Name
Phone Number (Parent/Guardian)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email - Parent/Guardian (If Available)
example@example.com
SECTION C: Educational Background
Name of last school attended?
*
Month and year you completed high school?
*
 -
Month
 -
Day
Year
Date Picker Icon
Which system did you study under?
*
Kenyan (KSCE)
British (IGCSE/A-Levels)
Other
What was you final grade or level achieved?
*
Have you attended any other program since finishing high school?
*
Yes
No
If you answered 'Yes' above, please specify. (If you answered 'No' above please write N/A)
*
SECTION D: Personal Reflection
What are you currently doing since finishing high school (e.g. at home, volunteering, working, waiting for university, etc.)?
*
What do you hope to gain from this program?
*
What are some challenges you face as a young Muslim today?
*
The program has four key modules. What would you like togain from each of these areas?(Critical Thinking as a Young Muslim, Building Strong Islamic Identity and Self-Awareness, Community Uplift and Social Responsibility, Career Guidance and Legacy Building)
*
Do you have any special needs or circumstances we should be aware of (health,accessibility, learning style, etc.)?
*
SECTION E: Commitment
Are you committed to fully participating in all activities, including communityservice and mentorship?
*
Yes
No
SECTION F: Referral Source
How did you hear about the Al-Fitrah Tarbiyah Youth Program?
*
Instagram
WhatsApp
Al-Fitrah Office
Friend
Other
SECTION G: Media & Data Consent
Consent for Photos and Videography: As part of the Al-Fitrah Tarbiyah Foundation Youth Program, photos and videos may be taken during sessions and activities. These images and recordings may be used strictly for Al-Fitrah Foundation's internal documentation, social media, promotional materials, and educational content. (All media will be used responsibly and will not be sold or shared externally. This is in full compliance with applicable data protection laws.)
*
I consent to the use of my/my child’s images and videos by Al-Fitrah Foundation for theabove purposes.
I do not consent to the use of my/my child’s images and videos.
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