Request edit access
CIMIC Weekend School Registration with Scholarship or Financial Assistance
Please only use this form if you are requesting a scholarship or financial assistance.
If you are able to pay the full price ($90 for Islamic Studies & Qur'an, $45 for Arabic class, per student), please register at
If you have any questions, please email Jazakumullahu Khair!
Primary parent (first name) *
Primary parent (last name) *
Primary parent's email address *
Primary parent's phone number *
Address (house or apartment number, street) *
Address (city) *
Address (state) *
Address (zip) *
Student's first name *
Student's last name *
Student's gender *
Student's age *
Student's date of Birth *
Emergency Contact Name *
Emergency Contact Phone Number *
Medical Needs
Arabic Class Level *
Islamic Studies & Quran
Clear selection
Scholarship Discount ($90 for Islamic Studies and Quran, $45 for Arabic) *
If other, I can pay this amount:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy