AdmissionsAalim - Alhussnain

Student Information

Name

First Name *

MI

Last Name *

Date of Birth *

Address

Address *

City *

State *

zipcode *

Contact

Cell Phone *

Home Phone

Work Phone

Email Address *

Country of Citizenship *

Country of Birth *

Student Time Spent in Jamaat *

3/10 Days
40 Days
4 Months

Education

Highest Level of Education *

Name of School *

GPA *

Years Attented *

Emergency Contacts

Emergency Contact1 Name *

Emergency Contact1 Phone *

Emergency Contact1 Email *

Emergency Contact1 Relationship *

Emergency Contact2 Name

Emergency Contact2 Phone

Emergency Contact2 Email

Emergency Contact2 Relationship

References

Reference1 Name *

Reference 1 Phone *

Reference 2 Name

Reference 2 Phone

Please provide brief answers

Reason to join madrasa *

Why you choose to come to AlHassnain *

Parent/Guardian Information

Name

Parent Name *

Parent Relationship to student *

Parent Phone *

Parent Email *

Parent Occupation

Time Spent in Jamaat *

None
3/10 Days
40 Days
4 Months

Tuition payment method *

Cash
Check
Zelle
Direct Deposit

How much Tuition can you pay? *

$250
$300
$500

Send Tuition via Zelle to info@alhussnain.org

Fill and Send ACH form to info@alhussnain.org or mail it to 5047 Deer Creek Pl, Indianapolis IN 46254

Mail your check to: 5047 Deer Creek Pl Indianapolis IN 46254

Provide following information about your child

Convictions

Medical Condition

Medical Insurance Provider *

Medical Insurance Provider Phone *

Marital Status *

Single
Married
Divorced

Government ID *

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I certify that this information is complete and accurate. I understand that making false statements within this application may result in denial of admission.

If admitted, I agree to abide by the policies set forth by the Institution and all of its rules and regulations.

Consent checkbbox *

I Agree

Student Signature *

Date *

Parent Signature *

Date *

=

Apply

Thank you for your interest in our Seminary

Student Information

Parent/Guardian Information