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Al---Bayaan Institute Application Form Student Information Form

Session:

Please use a separate form for each student. Please print all information clearly General Information

M F Child’s Name

Age

Guardian/Mother’s Name

Father’s Name

Home Phone

Mobile Phone

Home Phone

Email

Email

Address

Address

City, State, Zip

City, State, Zip

Grade in School

Mobile Phone

Has your child ever been diagnosed with a learning and/or medical disability and/or have you ever been made aware of any issue impacting your child’s learning ability. No Yes If yes, please describe below.

What is the primary language spoken at home?

Is your child receiving any ESL services at his/her current school?

Previous Quranic Studies Information Previous School Name(s) and Location(s): Briefly describe what the student studied, and for how long. Include Quran memorized, Tafseer, Tajweed, Arabic and Quranic Reading:

Intention Agreement The list of applicants currently exceeds the spaces available. This will mean that a selection process will need to take place. By going forward with this process it demonstrates that I am applying to put my child in the program starting May , 2018 and that we are preparing for this commitment. I further understand that if I'm interested in ABI as a future option, that this is not the process for me to engage in as I may take someone's opportunity to interview for the 2018 -- 2019 class. I also understand that there is a financial commitment that I must uphold as this is a private institute responsible for paying staff and rent.

I have read the above statement and intend to complete my application for 2018 – 2019.

(Father or Guardian)

(Mother or Guardian)

abi-applicationform-02-23-18  
abi-applicationform-02-23-18  
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