Apply Online SECTION 1: BASIC INFORMATIONName* First Last DOB* Place of birth*Nationality*Age*Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country LandlineEmail ID*Father's number & Mother's number*Main Spoken Language*How fluent is it?*fluentintermediatebasicParents'/Guardian’s Name* First Last Parent's OccupationParents Marital Status*MarriedSingleSeparatedPlease name the spouse that has the legal Responsibility of the child.Emergency Contact DetailsContact No.*Relationship*Do you have any sibling(s) studying at Darul Uloom?*YesNoPlease give their namePlease state your Ethnicity* SECTION 2: PREVIOUS EDUCATIONISLAMIC EDUCATIONCurrently StudyingSECULAR STUDIESReason for leaving SECTION 3: COURSE DETAILSSelect The Course You Are Applying For. Please Tick The Appropriate Box Below:* AALIM (Islamic Theology) HIFZ (Memorising the Holy Quran) Are you Applying for Boarding or Commuting?*BoardingCommuting SECTION 4: CURRENT HEALTH AND MEDICAL CONDITIONPlease provide more detailed answers to this section on a separate sheet of paper if requiredList any current or past (chronic) conditions affecting the applicant:Is the Applicant Taking Any Prescribed Medication? If yes, Please complete the following sectionDATE PRESCRIBEDDOSAGEREASON OF PRESCRIBINGPRESCRIBED BY Is the applicant allergic to any of the following: Penicillin, Paracetamol?*NoDoes the applicant have any other drug allergies?*NoIs the applicant allergic to bee/wasp stings? If yes, does he require a kit?*NoDoes the applicant have any other allergies (e.g. shellfish, peanuts, etc.)*NoHas the applicant had any serious injuries?*NoDoes the applicant suffer from bedwetting?*NoDoes the applicant suffer from Epilepsy?*NoDoes the applicant receive any treatment for any other medical conditions?*NoHas the applicant received a Tetanus injection in the last six months?*NoDoes the applicant have any Family history of major illnesses*NoDr’s Name, Surgery and addressNHS NumberHas the applicant or any of his family members had covid 19 or covid 19 symptoms in the last 14 days?*NoYesIs the applicant on a EHC (education, health and care) Plan ?NoYesDoes the applicant have ADHD ?NoYes SECTION 5: PARENTAL CONSENTPARENTAL CONSENT* I am the parent /Guardian of the applicant give authority to the school to administer First Aid and medical treatment under supervision & to provide Optical and dental treatment when necessary. SECTION 6: FEESBOARDING FEES The annual boarding fee for Al Jamiatul Islamiyyah is £2,950, We expect Parents to pay the fees in three instalments. We do stress that the fees must be paid promptly, any delay may lead to suspension or exclusion of the student from the school. COMMUTING FEE The annual commuting fee for Al Jamiatul Islamiyyah is £1,650. We expect Parents to pay the fees in two instalments. We do stress that the fees must be paid promptly, any delay may lead to suspension or exclusion of the student from the school. NOTE- There is a one off Administration Charge of £250 for boarding students and £125 Administration Charge forName of the designated fee payer (if applicable)Occupation SECTION 7: Safeguarding and Special needsHas the application had any involvement with Social Services or the Probation Services?*YesNoDoes the applicant have a SEND (Special Education Needs and Disabilities) statement?*YesNoHas the applicant been excluded permanently/tempararily from a previous school/madrasah/darul uloom or any other educational establishment?*YesNoPlease provide details below. SECTION 8: DECLARATIONI confirm that the information provided is correct to the best of my knowledge.*YesNoI consent to AL-JAMIATUL ISLAMIYAH to process my personal details, and the details of the applicant, in line with data protection laws.*YesNoI understand that if any information provided is found to be false even after acceptance, that applicant may be taken off roll at AL-JAMIATUL ISLAMIYAH.*YesNoThe applicant agrees with all current and future policies and procedures at AL-JAMIATUL ISLAMIYAH.*YesNoAll Persons listed as parent/guardian/emergency contact can be treated as the applicant's legal guardians.*YesNoparent declaration* I the parent/guardian have read and understood all the rules of Darul Uloom. The Information I have provided is accurate to the best of my knowledge and I ensure payment of fees as indicated above. child declaration* I the student have read and understood al the rules of Darul Uloom. If my application is accepted, I will abide by all rules of the Darul Uloom. I agree to take responsibility if I break any of the rules of the Darul Uloom. Please make sure you include on return of application: Drop files here or Accepted file types: jpg, png, pdf. (1) Copy of passport or Birth Certificate (2) Recent academic School Year Report (3) Madrasah report Any application sent without the above documents will not be processed