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CIMIC Weekend School Scholarship Form
Please only use this form if you are requesting a scholarship or financial assistance.
If you are able to pay the full price ($120 for Islamic Studies & Qur'an, $60 for Arabic class, per student), please register at
https://www.cimic.org/cimic-resource/sundayschool/
If you have any questions, please email
cws@cimic.org
. Jazakumullahu Khair
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Parent First Name
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Parent Last Name
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Email
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Phone
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Address
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City
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State
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Zipcode
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Student's First Name
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Student Last Name
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Gender
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Female
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Age
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Student's date of Birth
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DD
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YYYY
Emergency Contact Name
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Emergency Contact Phone Number
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Medical Needs
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Arabic Class Level (student will be further assessed for correct placement)
Level KG
Level 1
Level 2
Level 3
Level 4
Level 5
Advanced Topics
Not taking Arabic
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Islamic Studies & Quran (Current grade in school)
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Kindergarten (must be 5 years old)
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
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Scholarship Discount
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I am requesting a full scholarship
I am requesting a 50% scholarship
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If other, I can pay this amount:
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