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Alimiyyah / Arabic Intensive Application Form

Please complete the form below providing as much information as possible. Once the application is processed, the applicant will be invited for an interview.

Course Start Date: Jan 2025. Click here to find out more about our Alimiyyah programme. In the meantime, if you have any questions, please do not hesitate to contact us on: alimiyyah@nusratulislam.org or 07930423378

Fill in the form as accurately as possible and with correct spellings.

Applicant Details Applicant’s First Name* Applicant’s Last Name* Applicant’s Email* (required for online services) Applicant’s Mobile Applicant’s Gender MaleFemale
Date of Birth* Current status StudentEmployedUnemployedHouse-maker
Marital status SingleMarriedDivorced
Occupation/Year of study* Children Local Masjid

Address Address* Town* County* Postcode* Home Phone* (Landline Only)

Emergency Contact: Emergency Contact: First Name Emergency Contact: Last Name Emergency Contact: Mobile Select Relationship to Child Address Town County Post Code Home Phone (Landline Only)

Education: What is your level of Islamic Education: Can you recite the Qur’an YesNo
What are you secular education achievements*:

Notes: Please state any health issues*: Please state any allergies*:

You are only required to fill the following section if you are under 18.

Parent Details Parent’s First Name Parent’s Last Name Parent’s Email Parent’s Mobile Address Town County Postcode Home Phone (Landline Only)

Before submitting, please ensure correct spelling.

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