Application Form

1Student Details

2Parent / Guardian Information

3Health Information

4Document Upload

5Survey

6Academic Details – Weekend School

7Academic Details – WeekdaySchool

Student Details

Name(Required)

First Middle Last

Gender(Required)

Male

Female

Date of Birth(Required)

Place of Birth(Required)

Religion(Required)

Nationality(Required)

Address(Required)

Street Address City Region ZIP / Postal Code Country

Languages(Required)

Who does Child live with(Required)

Which of our Schools are you Applying For (Weekday or Weekend)?(Required)

Select Weekday School branch?(Required)

Select Weekend School branch?(Required)

PARENT/GURDIAN INFORMATION

Father's Full name(Required)

Marital Status(Required)

Mother's Full name(Required)

Marital Status(Required)

Health Information

Emergency Contact Name(Required)

Emergency Contact Number(Required)

Relation with Student(Required)

Office Address

Residential Address(Required)

Allergies

Does Student Have Peculiar Medical and /or Behavioral Conditions? Please Explain if Any?(Required)

Does Student have Diagnosed Learning Disabilities? Please explain if any?(Required)

Does Student have any special needs? Please explain if yes

Health Insurance Service Provider Name

Card Name

Card Number

Card Expiry Date

Prefered Hospital

Is Student Currently On Medication? Please State If any?

Family Doctor’s Name

Family Doctor’s Hospital Name

Location

Mobile Number

Document Upload

Proof of Payment

Accepted file types: jpg, pdf, png, gif, jpeg, Max. file size: 4 MB.

Birth Certificate

Accepted file types: jpg, pdf, png, gif, jpeg, Max. file size: 4 MB.

Last two terminal reports

Drop files here or

Max. file size: 4 MB.

Passport picture

Accepted file types: jpg, png, gif, jpeg, Max. file size: 4 MB.

Immunization records

Drop files here or

Accepted file types: jpg, pdf, png, gif, jpeg, Max. file size: 512 MB.

Survey

How Did You Hear About Iqra Educational Centre?

How Many Students Are You Enrolling Currently?

Before you click submit, kindly download the security form here print it and fill it for submission.

ACADEMIC DETAILS – WEEKEND SCHOOL

Previous Weekend School(s) Attended

Locations

Last Class Enrolled

ACADEMIC DETAILS – WEEKDAY SCHOOL

Previous Weekday School(s) Attended

Locations

Last Class Enrolled

Curriculum Used

Last External/national Exam Attended

Date Of External Exam

Centre Name