Summer 2026

Applicant's Full Name (First, Middle, Last):

First NameMiddle InitialLast Name
Other Name/Nickname (if any):
Date of Birth:

MonthDayYear
Date
Nationality (Passport):
Complete Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Full Name (First, Middle, Last):

First NameLast Name
Mother's Full Name (First, Middle, Last):

First NameLast Name
Father's Phone:
Format: (000) 000-0000.
Father's Email:
example@example.com
Mother's Phone:
Format: (000) 000-0000.
Mother's Email:
example@example.com
Guardian's Official Name (if other than father/mother):
Guardian's Relationship to Student:
Phone:
Format: (000) 000-0000.
Guardian's Address (if different from student's):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name (other than father/mother):
Relationship to Student:
Phone:
Format: (000) 000-0000.
Applying for
Name of last Madrasah attended (if any):
Date of leaving the previous Madrasah:
Reason for leaving the previous Madrasah:
Please state any serious illnesses, disabilities, allergies, specialized learning requirements, and/or other medical related information below:
For Office Use Only
Hifdh al Qur'an.
Admission Fee:
Monthly Tuition fees Amount:
Date:

MonthDayYear
Date
Nazim's Signature
Muhtamim's Signature

STUDENT PLEDGE
I, as a student of DARUL ULOOM MICHIGAN, solemnly promise that if I do anything against the rules of DARUL ULOOM MICHIGAN, I agree to obey any decision of the administration of DARUL ULOOM MICHIGAN.
1. I will follow all the laws of Shariah and the Sunnah of the Messenger Sallallahu Alaihi Wasallam and I will pray all salawaat.
2. I will not cut or shorten my beard and will keep my hair short. I will keep both according to the rules of DARUL ULOOM MICHIGAN.
3. I will not keep with me any type of electronic devices (such as cell phones, iPods, video games, CD/DVD/MP3 players, laptops, etc.). I also agree that if I break this rule, then DARUL ULOOM MICHIGAN has the full right to confiscate the item from my possession.
4. I will not lend or borrow money nor buy or sell anything to anyone in the DARUL ULOOM MICHIGAN.
5. I will not smoke or consume any type of drugs, intoxicants, or harmful substances.
6. I will not be involved in any type of fight with anyone or take the law upon my own hands nor will I ever disrespect any Ustaz/staff of the DARUL ULOOM MICHIGAN.
7. I will not have any type of unlawful (haram) relationship with anyone.
8. If I have any type of interview with any sort of media (such as newspapers, TV, etc.), I assure you that the DARUL ULOOM MICHIGAN and its staff/members are completely free from responsibility and completely uninvolved.
9. If I happen to perpetrate or get involved in any activities deemed to be illegal and or terroristic by the United States of America, I assure that the DARUL ULOOM MICHIGAN and its staff/members are completely free from responsibility and completely un-involved.
10. Whatever instructions that will be given from time to time, I will follow and obey them fully. I agree that if I break any of the rules of the DARUL ULOOM MICHIGAN, I will accept any decision of Darul Uloom Michigan, whether I am informed the reason of the decision or not.
11. (If I am a female) I pledge to abide by the laws of hijab and (Black) burqah pertaining to females in accordance with the laws of Islamic Jurisprudence.
12. (If I am a male) I pledge to abide by the DARUL ULOOM MICHIGAN Uniform i.e. white Islamic male hoodless Jubba not exceeding Nisfus Saqain (middle of the knee and ankle).
May Allah give me the ability to fulfill this Pledge. Ameen
Applicant's (Student) Signature

Student Fee Payment Authorization From
Please complete the following information & return this completed form to authorize payment collection.
Account Holder Name:
Account Type:
Bank Account Number:
Routing Number:
Amount (Onetime): $250.00
Tape Voided Check Here (*if account information has changed.)
I hereby authorize Darul Uloom Michigan to initiate monthly fee payments. This agreement remains in effect until I notify Darul Uloom Michigan in writing of any changes or cancellations. If I wish to withdraw my student from Darul Uloom Michigan, I must provide written notice at least one month prior to the intended withdrawal date. Darul Uloom Michigan will cancel the direct deposit from the next cycle upon receiving my written notification. If the direct deposit is canceled by me or my bank, I will be responsible for paying any applicable cancellation fees. By signing below, I acknowledge that I have read, understand, and agree to the above conditions.
Parent's/Guardian's Signature
Date:

MonthDayYear
Date
Should be Empty:

For Office Use Only

STUDENT PLEDGE

Student Fee Payment Authorization From