Pengajian Islam Tulab Education
Islamic Studies Registration Form
What program are you planning to enroll with?
*
Sijil Pengajian Islam (Malay)
Pra Diploma Pengajian Islam (Malay)
Certificate In Islamic Studies (English)
Choose the day of the program
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Please Select
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Student Information
Student Name
*
First Name
Last Name
Age
Date of Birth
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Month
-
Day
Year
Date
Gender
Male
Female
Phone Number
*
Email Address
*
example@example.com
Address
*
Street Address
Unit No
City
Postal / Zip Code
Does the student have any disabilities, illness, medical conditions, personal problems, etc. that can affect his/her virtual classes/study?
If you have any awards, recognition, certificates, please share them here:
Others
How did you learn about this virtual course?
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Referral
Other
Any additional comments or information you would like to share?
Student Signature
Print Form
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