Al Iman Application Form 2019-2020
Please be advised of the following:
1. Your child will not be enrolled until we receive all required documents: $25 Registration Fee, School Report Cards from current school year, Birth Certificate, Shot Records, and Recent Health Records.
2. Only complete applications with all documentation submitted to office will be given appointments for in-house testing.
3. Parents/Guardians completing the application have 7 days to submit payment and required documents. After this time, the application will be considered INACTIVE.

Notice of Nondiscriminatory Policy

Al-Iman school admits students of any race, color, national origin, and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national origin and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and athletic and other school-administered program.

Student First Name *
Your answer
Student Last Name *
Your answer
Grade for 2019-2020 School Year *
Has your child previously applied to Al Iman? *
Has your child been enrolled in Al-Iman School before? *
Does your child have siblings currently enrolled in Al Iman? *
If your child has siblings currently enrolled in Al-Iman, what is/are the sibling(s) name(s)?
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Home Address- Street, City, State, Zip Code *
Your answer
Home Telephone *
Your answer
Father's Full Name *
Your answer
Father's Cell Phone Number *
Your answer
Father's e-mail address *
Your answer
Mother's Full Name *
Your answer
Mother's email address *
Your answer
Mother's Cell Phone Number *
Your answer
Child lives with: *
Country of origin of child *
Your answer
Citizenship of child *
Your answer
Race of child *
Your answer
Does the child have any medical problems which the school should be aware of? If yes, please explain. *
Your answer
Does the child have any regular medication? If yes, please explain. *
Your answer
Does the child have any allergies to specific foods or medications? If yes, please explain. *
Your answer
Is this a special needs student? *
Does the child have a current PEP/IEP? *Please note: Children with emotional, learning, and behavioral disabilities cannot be accepted at Al Iman School, as programs are not available to meet their needs of these children. *
Does the child have ESL needs? Please note: *After accepting a student, if it is determined that he/she has inadequate familiarity with the English Language, the child may be requested to transfer to a school with an ESL program. Presently, ESL classes are not available at Al-Iman School. *
Does the student have Health/Medical Insurance? *
Medical Insurance Company Name
Your answer
Medical Insurance Policy Number
Your answer
Medical Insurance Group Number
Your answer
I hereby testify, to the best of my knowledge, that the above information is correct and accurate. *
Parent Signature *
Your answer
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