ArabesQ Islamic Academy

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Islamic Academy Registration Form

If you wish to leave any response blank, you may do so. Your answers will assist us in individualizing a program to meet your family's educational goals. Please list only the children who are registering for the Academy, not the ones not registering.

Your Name:

Spouses' Name:

Name/Birthdate of 1st child

Current grade level:

Entering grade:

Sarting month:

Email address:

Home Address:
City:
State and Zip:
Country:
Phone Number:

Has the student attended school before? Y/N
If yes what grades?
(Public): K 1 2 3 4 5 6 7 8 9 10 11 12
(Private): K 1 2 3 4 5 6 7 8 9 10 11 12

Last School Attended:
Last School Address:
Do you want records transfered from previous school? (Y/N)

Please enroll my student in the following:
Traditional School Program
Online School
Combination of Traditional and Online

Brothers/Sisters:
1 2 3 4

Does the student have a health problem? (Y/N)
If yes, please specify

Who will be the teacher?
Highest level of education achieved:
Islamic Affiliation: (Optional)
Would you like to join a local support group? (Y/N)

If my application for enrollment in ArabesQ Islamic Academy is accepted, I will comply with all requirements regarding reports, fees, and instruction. I understand that failure to do so will result in the cancellation of enrollment and loss of credits. In addition, ArabesQ Islamic Academy is hereby released from any liability for accidents, injury, or fire which may occur at the home/satellite school site.

Check ONE of the following methods of payment for monthly tuition:
I will pay by Check or Money Order each month via mail.
Please charge my tuition to my credit card or Checking Account each month.

Your credit card information is protected by E-commerce software.
What Option are you re-registering for?

Online
Unit studies only
Totally structured Program
Eclectic - A little of everything

What concerns do you have for this year that you didn't have last year?

With enrollment you will receive 2 semesterly reviews of your child's progress. Extra will be 25.00 per child per month. Will you need this?

Yes - Inshallah - How Many:
No

With the Academy Program you will need to supplement with Math program. Would you like us to purchase one? Or will you use worksheets from the internet?

Purchase Workbook $35.00 extra per child Inshallah
Purchase Saxon or Jacob's Text $100.00 extra per child Inshallah
I will purchase my own Inshallah
I will use the Internet Inshallah

What did you like about last year?

Any Special Interest?

What do you need specifically for the Academy?

Do your children have classes at the masjid and if so what are the learning?

Are all of your children Independent learners?

What type of Internet connection do you have?

Email Only
MSN Instant Messenger
AOL Instant Messenger Name:
Work Access Only
Other, please list:

Provide a little background information about your current homeschool style and what you would like to learn more of that the Academy can help with.

How would you like to pay?

Full tuition by August 1st
Monthly
Semesterly

List others:

Please detail all the information you think we need for the upcoming year for your child.

Is there anything else you would like to tell us?