Part-Time Arabic Language Program
This is the application for the PART-TIME Arabic course at Madina Institute USA. It is open to RESIDENTS ONLY, as it is an interactive live class, every Tue & Thu, 6:30-9:30pm. You must be age 16+ to apply. We will contact you shortly about tuition payments, Insha'Allah. Please note that spots are limited in the class and one must make their first tuition installment in order to secure their seat. Thank you!
Email address
Full Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Gender
Home Address
Your answer
Cell Phone Number
Your answer
Can you receive text messages at this number?
Payment Info
You may make your tuition payments at the masjid (credit card, cash or check) with Sister Sara, our office manager. (Note: Financial aid is not available for this course.)
Please choose your method of tuition payment:
What other previous experience/study have you had in Arabic?
Your answer
How did you hear about this course?
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms