Islam Comprehensive Preliminary Registration

Please fill out the form below to register for the Islam Comprehensive program.

Islam Comprehensive Registration

I am registering for *

Full 2-year diploma program

Arabic Course Only (March 2021-June 2021)

1 Year only (3 courses)

Other: Please expain

Please explain below

Custom course selection

Have you previously enrolled in Islam Comprehensive? *

If you answered yes above, and did not complete the program, please explain the reason.

Last Name *

First Name(s) *

Date of Birth *

dd/mm/yyyy

Gender *

Address *

City *

Province *

Email Address *

All correspondence will be sent to this email. Please assure it is valid and checked regularly.

Phone *

111-222-3333

How do you plan to pay the fees for this program? (You will not be charged anything at this time) *

How will you attend classes? *

How did you hear about the course? *

Google Search

Facebook

Newspaper

From a friend

Masjid

Other

Other Information

If there is anything else you would like to tell us, please mention it here.

If you are human, leave this field blank.