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Islam Comprehensive Registration
Taha
2020-05-18T18:03:25-07:00
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?
*
Yes
No
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
*
Male
Female
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)
*
Lump sum for full two years (6 courses): 10% discount will apply
Lump sum for first year (3 courses): 10% discount will apply
Per course
Per month
How will you attend classes?
*
Online Only
Onsite Only
Sometimes Online and Sometimes Onsite
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.
Submit