Admisson to Jamia Qurania Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Student Name *FirstMiddleLastDate of BirthPlace of BirthFathers NameFather's Place of BirthMothers NameMother's Place of BirthAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeApartment NumberHome Telephone NumberCell NumberEmail *Child Previous School (Name)Child Previous School AddressChild Previous School PhoneEmergency Contact NamePhoneDoes your child have any of the following?AsthmaHeart DiseaseEpilepsyAlergyOthersMental or Physical Handicap? if yes specify:Does your child have any sight, hearing, or any other impairment that would required attention?Are there any activities that your child should refrain from?Mode Of PaymentMoney OrderCheckCashAdmissions Requirements For JMC, Jamiah Qur'ania AcademyFor Official Use Only Return the completed application along with the following: Offcial Identifications, ie passport or birth certificate Most Recent Report Card and and other relevant schoold records. Most recent immunization records. Most recent utility bill, i.e gas or phone bill. Registration fees of $100 plus one monthly tuition fee of $350; cash, or check/money order payable to Jamaica Muslim Center Terms and Conditions of the JMC, Jamiah Qur'ania Academy Accepting students for Hifz course from 4th grade, for Intensive course from 9th grade School schedule Monday to Friday 8:30 am to 4:30 pm. The applicant acceptance decision is made by the administration of JMC, Jamiah Qurania Academy, after testing is completed and relevant information has been received and processed. The administration reserves the right to accept or reject the applicant. The Academy also reserves the right to exclude any student permanently or temporarily at any time that the Administration deems appropriate, either in the interest of the student or for the good of the school. Signature (You can use your mouse or tablet pen to sign) * Clear Signature Submit
