Admission Application – IQRA SCHOOL

Student

Name*

First Last

Applying for Grade*

Gender*

Birth Date*

Birthplace City*

State*

Country*

Enrolled Siblings*

No

Yes

Siblings

First Name

Last Name

Last School Attended*

Student is currently attending another school or has attended another school in the past.

Iqra School will be the first school this student will attend

School Name

City

State

Country

Type

Race*

Student’s Home Language*

Has student attended Iqra School before?*

Name, Address and Phone of medical source*

Name

Address

Phone

Name, Address and Phone of dental source*

Name

Address

Phone

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Mother's Name*

First Last

Phone*

Email*

Father's Name*

First Last

Phone*

Email*

What is the best way to reach you?*

Phone

Email

Emergency One Contact Name*

Emergency One Contact Phone*

Emergency Two Contact Name*

Emergency Two contact Phone*

Alternate Authorized Pick up*

Alternate Authorized Pick up

Academic Reports

Max. file size: 512 MB.

Health Reports

Max. file size: 512 MB.

Behavioral Reports

Max. file size: 512 MB.

Copy of Birth Certificate

Max. file size: 512 MB.

Up-to-date Immunizations

Max. file size: 512 MB.

Any dietary or medical needs

Max. file size: 512 MB.

Any Individual Child Care Program (ICCP) needs

Max. file size: 512 MB.

Application Fee

Price:

Credit Card

Card Details

Cardholder Name

Signature (Your full name)*

Today's Date*