Al-Quran Institute of Memphis - Application for Admission
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Al-Quran Institute of Memphis - Application for Admission Student Information [Please fill out this section Only if registrant is an Adult (15yrs+)] First Name: _________________________ Last Name: _________________________ Home address: _________________________________________________________________ Gender: _________ Phone #: ________________ Email address: ______________________ ------------------------------------------------------------------------------------------------------------------- Child Information [Please fill out this section Only if registrant is a Child/Youth (4-15yrs)] First Name: _________________________ Last Name: ________________________ Date of Birth: _________________ Age: _______ Gender: ___________________________ Legal Guardian’s Name: ________________ Emergency Phone Number: ___________ Parent’s Information: Mother’s First Name: ______________Last Name: ____________Phone number: ___________ Home address: _________________________________________________________________ Father’s Last Name: _________________ Last Name: ___________ Phone number: _________ Permissions: Legal guardian gives permission to the institute: 1. To provide emergency medical treatment to the student including a call to 911. 2. To publish picture(s) & student’s accomplishments for publicity of the student & the institute. Liabilities: 1. The legal guardian gives his/her consent that he/she will not hold the institution liable for any accidents or any medical treatment(s) 2. In case of any emergency, the institution will try to contact the legal guardian through the phone number(s) given above. Signature of legal guardian: _____________________________ Date: __________________ PLEASE select one of the offered programs on the other side of the brochure For Office Use only: Amount Due: ___________ Amount Paid: ______________ Balance: _________________ Payment Type: □ Check □ Cash □ Credit Card □ Online
Transcript of Al-Quran Institute of Memphis - Application for Admission
Al-Quran Institute of Memphis - Application for Admission
Student Information [Please fill out this section Only if registrant is an Adult (15yrs+)]
First Name: _________________________ Last Name: _________________________
Home address: _________________________________________________________________
Gender: _________ Phone #: ________________ Email address: ______________________
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Child Information [Please fill out this section Only if registrant is a Child/Youth (4-15yrs)]
First Name: _________________________ Last Name: ________________________
Date of Birth: _________________ Age: _______ Gender: ___________________________
Legal Guardian’s Name: ________________ Emergency Phone Number: ___________
Parent’s Information:
Mother’s First Name: ______________Last Name: ____________Phone number: ___________
Home address: _________________________________________________________________
Father’s Last Name: _________________ Last Name: ___________ Phone number: _________
Permissions: Legal guardian gives permission to the institute:
1. To provide emergency medical treatment to the student including a call to 911.
2. To publish picture(s) & student’s accomplishments for publicity of the student & the institute.
Liabilities:
1. The legal guardian gives his/her consent that he/she will not hold the institution liable for any
accidents or any medical treatment(s)
2. In case of any emergency, the institution will try to contact the legal guardian through the phone
number(s) given above.
Signature of legal guardian: _____________________________ Date: __________________
PLEASE select one of the offered programs on the other side of the brochure
For Office Use only:
Amount Due: ___________ Amount Paid: ______________ Balance: _________________
Payment Type: □ Check □ Cash □ Credit Card □ Online
Fee Structure:
Children: $60/month (first child)
$50/month (2nd/3rd/4th)
Working Adults: $60/month
University/College full time students may receive up to 50% discount
Financial assistance available for dedicated stu-dents unable to afford the full fees.
Program Start Date:
August, 11th, 2014.
Onsite registration: August 4th-6th, 2014
Program Location
Masjid Ar-Rahman: 7906 Lowrance Rd, Memphis, TN 38125
Masjid Al-Noor: (Weekend program) 3529 Mynders Ave, Memphis, TN 38111
Program Director: Sh Mohammed Elkadi
Sh Elkadi holds
Assistant Director: Hafidha Susan Ibrahim
Sr. Ibrahim holds an Ijaza in Quran recitation & memorization from Sheikh Mohammed Alminisi
Administrative Director: Dr. Iqbal Shafi
Online Registration: Online registration is
available at www.masjid-arrahman.org
Programs: [PLEASE circle the program that you/child would to enroll in]
1a: 4-6 yrs. children: Tuesday & Thursday:11:00 am – 1:00 pm
Reading and Writing
1b: Sisters all ages: Tuesday & Thursday:11:00 am – 1:00 pm
Recitation with tajweed, meaning, hifz
2: 6-15 yrs. (Group I) Monday & Wednesday: 5:30 pm – 7:00 pm
(Boys & Girls)
Recitation w/ tajweed, Hifz, meaning, Hadith
6-15 yrs. (Group II) Tuesday & Thursday: 5:30 -7:00 pm
(Boys & Girls)
Recitation w/ tajweed, Hifz, meaning, Hadith
3: 15 yrs.+ (Adults) Monday and Wednesday: 8:30-10:00 pm
(Brothers only)
Recitation w/ tajweed, Hifz, meaning, Hadith
4: 6 –15 yrs. Saturdays or Sundays: 10:30 am–1:15 pm
*Location: Masjid Al Noor*
Recitation w/ tajweed, Hifz, meaning, Hadith
5: All ages Individualized, dedicated Hifz Program
Goal: to memorize the Quran in 1-2yrs inshallah
*Location: Masjid Ar-Rahman & Al-Noor*
Note: Placement test will be administered for all classes
