Part Time Islamic Studies Application 2019 - 2020
Please fill this application out to be considered for the Part-Time Islamic Studies program for the academic year 2019 - 2020. The details of the course, as well as the course syllabus, can be found here:

http://madinainstituteusa.org/wp-content/uploads/2017/06/Part-Time-Islamic-Studies-Syllabus.pdf

Note: Syllabus is tentative and subject to change, but any major changes will be communicated to students in a timely manner.

Email address *
Are you Applying for the on-site class or the online option? *
Confirm Email Address *
Your answer
First Name *
Your answer
Last Name *
Your answer
Gender *
Phone number *
Your answer
Can you receive texts on this phone? *
Date of Birth *
MM
/
DD
/
YYYY
Complete Mailing Address *
Your answer
How did you hear about this program?
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Madina Institute. Report Abuse - Terms of Service