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ICN Alimiyyah Programme Registration Form
Please fill in the following registration form to register for the Alimiyyah programme.
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* Indicates required question
Email
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Your email
Surname
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Your answer
Forename
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Your answer
Home Address
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Your answer
Postcode
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Your answer
Tel: Home
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Your answer
Tel: Mobile
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Your answer
E-mail
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Your answer
Gender
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Male
Female
Age
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Your answer
D.O.B
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Your answer
Parent / next of kin details: Surname
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Your answer
Parent / next of kin details: Forename
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Your answer
Parent / next of kin details: Home Address
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Your answer
Parent / next of kin details: Postcode
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Your answer
Parent / next of kin details: Tel: Home
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Your answer
Parent / next of kin details: Tel: Mobile
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Your answer
In 500 words or less, please describe any details about your personal background, especially with regards to your experience in Islam, that you believe would support your application.
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Your answer
To facilitate your learning we would like to know about your secular educational background in order to best cater for your academic needs. Please tell us about any academic qualifications you have obtained.
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Your answer
Your expectations and objectives: Please tell us about (1) your expectations of the course and (2) your objectives for attending. Please make sure to attempt both parts of this question.
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Your answer
Please tell us about your Islamic education, teachers, and your interests. i.e. have you attended any institutions or which classical books have you been through if any?
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Your answer
Which method of study do you prefer?
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On site (Face to face classroom based)
Online
Would you require accommodation?
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Yes
No
Do you have any medical conditions or requirements i.e. asthma / any allergies?
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Yes
No
If you answered yes to the previous question, please provide further details regarding your medical conditions or requirements. If no, please write N/A.
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Your answer
Declaration: I declare the information I have provided to be true to the best of my knowledge and I agree to abide by the rules and regulations of the institute. Please write your full name in upper case and then the date.
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Your answer
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