Al-Rashid Islamic Institute Student Application Form
بسم الله الرحمن الرحيم
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Email *
I understand this a new student waitlist / application form, and I will only be contacted If I get approved for admission. *
Applicant First Name *
Applicant Middle Name
Applicant Last Name *
FATHER’S / GUARDIAN’S NAME (FIRST AND LAST) *
MOTHER’S / GUARDIAN’S NAME (FIRST AND LAST) *
STREET NUMBER *
STREET NAME *
APT/UNIT
CITY *
PROVINCE / STATE *
POSTAL / ZIPCODE *
DATE OF BIRTH *
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GENDER *
HEALTH CARD NUMBER
PARENT/GUARDIAN PHONE NUMBER *
HOME NUMBER *
FATHERS/GUARDIANS EMAIL *
MOTHERS/GUARDIANS EMAIL
Student is living with? *
Is there a custody order in place for this student? *
When do you wish to commence studies? *
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Have you previously registered at this institute? *
Which program(s) are you applying for? *
Required
Previous grade completed *
Are you fluent in English? *
Please select one of the following *
List present or previous school / Educational institute attended *
Please provide: Year Enrolled - Name of School/Educational Institute - Grade/Program Completed - City/Country
Was the applicant expelled / suspended from any previous school? *
Does the applicant have a criminal record or any pending criminal charges? *
Have you or anyone in you household tested positive for Covid-19? *
If you or anyone in your household tested positive for COVID, please provide the approximate date.
Have you received the Covid vaccine? *
If the COVID vaccine was made mandatory for admission at Al-Rashid (students age 12 and above) would you still be interested in admission? *
Do you have any allergies or medical conditions? *
If yes please provide more information in the section below
ALLERGY AND MEDICAL CONDITIONS DETAILS
Provide information/details regarding the students allergy or medical condition.
RULES, REGULATIONS, AND POLICIES
1. The Student will be required to follow the sacred Shariah and Sunnah of the Holy Prophet Muhammad (sallallaho-alaihiwasallam) in all aspects of life at the Institute.

2. The student must practice acceptable manners of politeness and social behavior towards fellow-students, faculty, and staff of the Institute.

3. The student must have regard for the general cleanliness of the property and his dormitory.

4. The student will be permitted to leave the Institute only during vacations as determined by the Institute. The Principal may
grant special leave when deemed necessary upon written request from a parent/guardian. The student must attend all classes and activities of the Institute unless permission is obtained from the principal.

5. The student is not permitted to own or use any small or major appliances, (Ex. toaster, fridge, microwave, deep fryer, etc.)
media/entertainment devices, (Ex. video game devices, cell phones, audio, and video devices, etc.) or fitness equipment. (Ex.
exercise bike, bench press equipment, etc.) If any of the fore-mentioned property is found, it will be confiscated and may be
returned at the sole discretion of the principal. The data on any electronic devices may be subject to inspection; a student
forfeits any privacy by possessing any electronic devices without prior permission. Under special circumstances, students may
obtain explicit permission from the principal to own or use certain property.

6. All costs incurred as a result of the damaged Institute property caused by the student will be paid by the student/parent/guardian.

7. Al-Rashid is not responsible for any injury sustained by a student. The student is responsible for any medical or dental costs
incurred. The damage or theft of personal property is also the sole responsibility of the student.

8. The student or parent/guardian must disclose any physical or mental disorders of the student before enrolling in the Institute.

9. The student or parent/guardian must disclose any history of involvement with the police or the judicial system.

10. Certain areas of the Institute are monitored by security cameras for the purpose of safety, prevention of criminal activity, and
enforcement of the Institute’s rules and regulations. Any evidence collected thereby will be used in the investigation and
prosecution of any criminal activity.

11. All new applicants may be subjected to a personal interview with the principal. Students may also be subjected to an admission test in religious and secular school subjects.

12. The annual fee may be revised at the discretion of the Institute.

13. The student/parent/guardian agrees not to pursue any legal recourse should the student be subjected to correctional measures, including but not limited to detentions, suspensions, or expulsions.

14. Violation of any rules or regulations may be deemed sufficient for expulsion from the Institute at the principal’s discretion
I certify that all statements on this application are correct and complete. I understand that my admission or registration is subject to cancellation at the sole discretion of the Institute. I agree with the rules, regulations, and policies listed above , as well as any additional requirements that may be imposed by the Institute. I understand that this application does not guarantee enrollment. I authorize the Institute to act as a legal guardian and make any decisions, including medical decisions on my behalf. *
eSignature of Student ( If student is over 18)
Please sign with your full name
Date of Student signature
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eSignature of Parent /Guardian *
Please sign with your full name
Date of Parent / Guardian signature *
MM
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