Special Educational Needs Form
Alhamdulillah after receiving an extremely positive response to the idea of a SEN Madrassah, Darul Ilm will be opening it's SEN Madrassah in January InshaAllah

Please fill out the form below to enroll your child
Email address *
Full name:
Date of birth
Age:
Gender
Clear selection
Language(s) Spoken
Fathers full name and contact details
Mothers full name and contact details
Address:
Post code:
Contact number:
Landline:
Email:
Medical Diagnosis:
Medication:
Any Medical condition/ Allergies
Name and contact number of GP
Has the applicant attended madrasah before, if so what did he/she learn?
Name of secular school attending
Has the applicant got an EHCP / statement of need or IPRA?
Submit
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